Comprehensive View on Care for Patients with Urostomy

Early and Late Complications

A significant portion of complications with urostomy using the small intestine falls into the category of early complications, occurring within 90 days post-surgery. These include paralytic ileus, intestinal obstruction, or anastomotic defect. Up to 80% of patients with an ileal conduit may have asymptomatic bacteriuria and face the risk of developing pyelonephritis.

Late complications, occurring after 90 days from stoma creation, are the most common reason for reoperation following cystectomy. These include parastomal hernia, stoma stenosis, or necrosis. In a retrospective analysis dealing with the incidence and causes of repeated hospitalization after radical cystectomy, it was found that 13% of patients needed hospitalization due to urinary tract obstruction, 12.4% due to pyelonephritis, 11.9% due to intestinal obstruction, and 11.3% due to metabolic acidosis.

Postoperative care for ostomy patients should therefore focus on preventing infections, renal and metabolic complications, and patients should be properly educated in this regard. Metabolic issues include malabsorption, diarrhea, or electrolyte disorders, so regular medical check-ups are essential for ostomy patients.

Care for Peristomal Skin

The skin around the stoma can also be a source of complications. Although urine, unlike intestinal contents, does not contain enzymes that cause skin damage, moisture can cause issues. On macerated skin around the stoma, erythema accompanied by burning pain may appear. Such issues can be resolved using the correct stoma appliances and accessories, such as pads or powders; if there is frequent urine leakage, the stoma size needs to be checked. A doctor caring for a new ostomy patient should inform the patient about the appearance and natural changes of the stoma in the first 8 weeks and the signs of local or systemic infection. In the postoperative period, it is crucial to explain to the patient how to care for stitches and how their presence can affect the choice and use of ostomy devices.

Emphasis on Complication Prevention

Proper hydration is a crucial step in preventing many complications following urostomy. The patient should be informed about the principles of fluid intake, and the doctor should explain the importance of adherence. Fluid intake should range between 2 and 2.5 liters daily, with a minimum output of around 800 ml/24 hours. It is also appropriate to educate the patient about the impact of diet on urine pH.

After stoma creation, patients face significant changes in all spheres of life. Besides the actual care for the stoma, the doctor should explain all the implications for personal, work, and intimate life, give the patient an opportunity to ask about anything related to the new life situation, and be able to refer to additional sources of information. Patients who are well educated about their condition in all aspects are better able to recognize potential complications or health deviations and cope much better with the changes entailed by stoma creation.

Conclusion

The ability and motivation to care for oneself after such a significant physical and social change as urostomy creation vary greatly among patients. Influence can stem not only from their health status but also from education, cognitive and psychomotor abilities, or family ties. These aspects need to be considered in ostomy care, and various evaluation tools should be used in education, such as the Urostomy Education Scale developed specifically for assessing the level of self-care in stoma patients.

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Source: Berti-Hearn L., Elliott B. Urostomy care: a guide for home care clinicians. Home Healthc Now 2019 Sep-Oct; 37 (5): 248–255, doi: 10.1097/NHH.0000000000000792.