From the Guidelines
Caring for a urostomy requires a comprehensive approach that includes preoperative counseling, proper stoma site marking, and postoperative education to ensure optimal outcomes and quality of life. According to the most recent study 1, preoperative counseling with stoma marking is crucial in reducing postoperative problems such as leakage, peristomal dermatitis, and difficulty with self-care.
Key Components of Urostomy Care
- Emptying the urostomy pouch when it's one-third to one-half full, typically every 2-4 hours during the day and before bedtime
- Changing the entire appliance every 3-7 days or sooner if leakage occurs
- Gently cleaning the stoma and surrounding skin with warm water and mild soap, patting dry completely, and measuring the stoma regularly as its size may change
- Applying a skin barrier paste or rings around the stoma to prevent urine from contacting skin, then attaching a clean pouch, ensuring a snug fit with no wrinkles
- Monitoring urine output for color, consistency, and volume, drinking 8-10 glasses of water daily to maintain proper hydration and prevent urinary tract infections
Importance of Preoperative Counseling and Stoma Marking
The study by 1 emphasizes the importance of preoperative counseling and stoma marking in improving patients' ability to independently change a stoma appliance postoperatively. This is supported by the use of the Urostomy Education Scale, a reliable tool to evaluate urostomy self-care skills after cystectomy.
Postoperative Care and Follow-up
Postoperative care is also crucial, and patients should be educated on how to care for their stoma and manage any potential complications. Regular follow-up with an enterostomal therapist or a specialist urology nurse clinician is essential to reinforce teaching and troubleshoot any difficulties, as recommended by 1.
Quality of Life and Independence
Proper care and education can prevent complications like skin breakdown, infection, and leakage, promoting independence and quality of life. Patients should be encouraged to contact their healthcare provider or ostomy nurse if they experience persistent skin problems, stoma changes, or urinary issues.
From the Research
Caring for a Urostomy
To care for a urostomy, it is essential to understand the risks of urinary tract infections (UTIs) and how to prevent them.
- UTIs are a common complication after cystectomy, with a median rate of 20% 2
- Perioperative antibiotic prophylaxis can help reduce the risk of UTIs, but the duration and choice of antibiotics vary widely 2
- A systematic review found that prophylactic antibiotics before stent removal can lower the median percentage of positive blood cultures after stent removal (2% vs 9%) 2
Preventing UTIs
Preventing UTIs is crucial in urostomy care.
- A randomized double-blind placebo-controlled trial found that single-dose antibiotic prophylaxis before urinary catheter removal does not reduce the risk of UTI in surgical patients 3
- A systematic review with meta-analysis found that ciprofloxacin is a safe and effective therapeutic alternative for the treatment of acute or complicated UTIs in adults 4
- A prospective descriptive study found that Escherichia coli is the most common causative pathogen of UTIs, and that extended spectrum beta-lactamase (ESBL) producing E. coli is the most commonly detected organism 5
Management of UTIs
Managing UTIs is an essential aspect of urostomy care.
- A study found that high rates of resistance to commonly prescribed antibiotics were detected, and that drug-related problems (DRPs) such as inappropriate antibiotic dosage and unnecessary antibiotic prescribing were relatively common 5
- A study exploring interventions and strategies implemented by NHS commissioning organisations in English primary care found that education and training were the most reported intervention types, and that reducing antibiotic prescribing was a common success measure 6