The Happy Urostomate

Articles Included:

· Urostomy Question

· Urostomy Complication

· A Urostomy Experience

· Bladder Cancer

· Bladder Cancer

· Hints for New Urostomy Patients

· Tips for Urostomates

· Urinary Diversion: Past, Present and Future

· Tips & Hints

· Urostomate and Fluids

· Urostomates

· Cautions for Urostomates

· Urostomy Change Procedure One

· Urostomy Change Procedure Two

· Urostomy Complications

· Urostomy Care

· Urinary Ostomy

· Acidic Urine

· Urinary Infections

· Urinary Diversions

· Urostomy Care

· Infection in Urostomies

· Advice for Urostomates

Urostomy Question

Dear Renard, 

My friend found you on your Internet site, www.uoachicago.org , when we were wondering about urine specimen collection and appreciated your help.  I have another problem which I have discussed with the ConvaTec ET nurse.  I had been having problems with itching under my flange and it has been partially resolved since I started routinely cleansing the area with the adhesive remover and washing it all with Ivory soap.  I do rinse the area well to remove all the soap residue but have a problem with the length of time my bag stays on.

It will last a week and then the next week I have to change it three days in a row.  My routine is the same and nothing is significantly different in my diet or fluid intake.  I have had an ileo-conduit for almost five months now.  I use stoma paste around the cut-out hole which is measured to snuggly fit my stoma.  I would appreciate any thoughts or suggestions you may have to help me get a week out of every change.  I never wear it more than seven days when it lasts. Thanks for your help in advance.

Nancy

Dear Nancy,

We have asked this same question many times to a variety of ET nurses as well as some of the scientists at Hollister, Inc. 

The best method of changing an extended wear barrier—I believe you are probably using one—is a little different than your current routine.  After removing the barrier, an adhesive remover should be used only sparingly, maybe once a month or so, because the alcohol in it will dry the skin and make it itch.  Also, there is virtually no need to ever wash the skin around the stoma with any type of soap, especially Ivory.  Soap will dry out the skin and make it itch.  Wash the skin that is under the barrier with only warm water and gentle hand rubbing, it is all that is necessary.

You probably should not use paste with a urostomy.  The residue from it may enter the stoma and cause infection.  Most urostomy patients use a convex wafer with perhaps a belt to hold it in place to achieve satisfactory results from their ostomy system without any leaking. Using a flat barrier may lead to leaks and not offer you the same wear time. 

An ostomy system managing a urostomy should be changed about twice a week on average.  If you are trying to make it last a week, it may not be prudent.  The skin under the barrier needs to checked every few days to make sure there is no damage from a minor leak.  Just a drop of two of urine under the barrier will compromise the skin over time.  It is best to catch these little problems early, and we all get them. 

If there is still itching under the barrier—this can be very annoying and significantly diminish one's quality of life—a dermatologist can prescribe Desonide lotion.  Only a drop is necessary, and it will stop the itch.  It is a steroidal based product and is not recommended for every day use because it may thin the skin and be absorbed by the skin and enter the body.  Regardless, it is a miracle for people with itching issues.

In addition, if there are any red pin-head sized bumps on the peristomal skin, this may mean the presence of fungus.  This will cause itching.  Using a micro-granulated anti-fungal powder will solve this problem.  Your doctor can give you a prescription for Nicostatin powder, a must for all people with ostomies. I hope this little bit of information has been of help,

Renard

Urostomy Complications

Forward By The Ostogram, Dayton, OH

People with urostomies have a high incidence of complications due to their surgery ... some occurring after 10-12 years. Most complications occur gradually.

One of the most common is caused by an ill-fitting pouching system. A barrier opening that is too large will result in urine that accumulates on the skin around the base of the stoma. The skin may become reddish-brown with raised, thick, leather-like areas. It is important to have a barrier opening that fits up to the stoma to prevent this and other long-term complication.

If the reddish-brown growth is extremely bad, it may be treated with soaks of white vinegar three times a day for three or four days. Vitamin C, taken according to directions, may also be helpful to acidify the urine. Alkaline urine on the skin is irritating. If these measures are not successful, a revision of the stoma is an alternative.

Encrustations or sand-like deposits on or around the stoma are another complication. When these deposits are noticed, start to increase your intake of cranberry juice along with the Vitamin C. Your physician may order Mandelamine to increase urine acidity even more. Orange juice is not recommended because of the high alkaline ash residue it leaves.

One part vinegar to two parts water sloshed over the stoma helps if done once or twice a day. This encrustation can clog up the stoma and eventually cause a closure of the stoma.

Recurrent urinary tract infections are prevalent in most people with a urostomy. Most of you know the symptoms: fever, a strong urine odor, decreased output, amber-colored urine with a large amount of white sediment. You may need more fluids. You should be sipping water all through the day ... at least two quarts of water each day. This will reduce infections and prevent kidney stones.

Remember: The urine coming out of the stoma is sterile; i.e., no bacteria is present. Once it goes into the pouch, bacteria immediately starts to grow. It is important to empty your pouch when it is less that 1/3^rd full and to maintain cleanliness in anything that comes near the stoma.

A Urostomy Experience

By Becky Redmond, Forwarded By ReRoute, Evansville, IN

I have been reading articles on your site for a couple of years. I had an unusual and frightening experience concerning my urostomy last week that I thought might be of interest to your readers.

I have had my stoma for four years now and have had no complications or problems. For the past six months, I had noticed that the skin around my stoma was white and irritated. I tried several different things to clear it up: changing to different brands of ostomy systems; changing the barrier more often; drinking more water and cranberry juice; using different powders ... but nothing seemed to clear it up.

I knew, I should get in to see the doctor. But with starting a new job this summer, I couldn’t afford to take time off. So, I just put up with it, hoping that once I had enough time at my new job, I could take off and then get in for an appointment.

While at work last Thursday, I went to empty my pouch, and it was full of bright red blood. I noticed two small blood clots. This really got my attention and I went directly to the phone and called the doctor who had performed my surgery four years ago.

The nurse said she would leave a message for him and he would call me back. Meanwhile, I continued to work. I started drinking a lot of water and drank a bottle of cranberry juice, thinking this would clear things up. After lunch in the early afternoon, I again went in to empty my pouch and this time it was not only full of bright, red blood but so full of huge blood clots that my pouch wouldn’t even drain!

I was so scared that I went immediately to the phone and told the nurse that I had an emergency situation and needed to talk to the doctor. I ended up at the emergency room and had a urologist come in to look at it. When I took off the pouch, the blood had coagulated so thick that the doctor couldn’t see the stoma.

He peeled off the barrier and blood was spurting from a severed artery next to the stoma. He said that because the skin around the stoma had such severe erosion it caused the breakdown by the artery and broke loose. He had to put in several stitches to close the artery. I had lost quite a bit of blood but not enough to keep me in the hospital. So, I was released and went home.

I was told my urine would clear up later that evening ... which it did. It took several days for me to get over the panic of what had happened. Because of this ordeal, I made an appointment with an ET nurse. She told me that she recommends that people with urostomies wear a convex flange. It keeps the urine from pooling around the stoma area. And, she showed me how to use powder and paste on the white, moist areas surrounding my stoma. I have also scheduled an appointment with my doctor to have him follow-up on the excellent care provided by the emergency room urologist. The ER urologist told me that in 25 years of practice this was only the second time he had ever seen this happen. I guess he doesn’t see too many urostomy stomas.

Bladder Cancer

By T.R.. Van Dellan, M.D.

Most tumors of the urinary bladder are malignant. They are likely to develop after the age of 50, and men are more susceptible than women. At least 95 percent of these tumors are carcinomas or papillomas. These cancers are unique, especially papillomas. When the first tumor is removed, another develops months or years later.

It is a new lesion and likely to be more malignant than the first. And this type of recurrence may happen over and over again. This is why urologists insist on looking into the bladder every three to six months after the first neoplasm is removed.

The incidence of bladder tumors is increasing among our population. It is estimated that in 2004 over 56,000 new cases will be reported. Overall, bladder cancer incidence is about four times higher in men than in women. On the other hand, the death rate has not risen due, perhaps, to improvements in early diagnosis and treatment.

Cancers of the bladder may grow for varying periods of time without producing any symptoms. They are always suspected when the individual suddenly, and for no apparent reason, urinates blood. Should this painless, but serious, sign develop, consult with your physician without delay. He/she may recommend a urologist who will try to find the source of the bleeding. If nothing is done about the sudden bleeding, it may stop spontaneously. However, signs of bladder irritation and infection may soon ensue with quinsy, urgency, and difficult and painful urination.

Diagnosis is made by looking into the bladder with a cystoscope and doing a biopsy. With this procedure, the surgeon determines the size, shape, and location of the tumor. In some instances, the top of the lesion has sloughed off leaving a bleeding ulcer.

A pap test of the urine may reveal cancer cells. X-rays of the kidneys and an examination of the prostate gland in men, complete the study. Some vesicle tumors can be removed with electro coagulation or cutting electric currents inserted through the opening in the scope. Radon seeds can be inserted in the same way. Serious lesions require abdominal surgery, which involves removal of part of or the entire bladder.

Bladder Cancer

--S. Brevard, Fl Ostomy Newsletter

Cancer appears in the bladder more often that in any other organ of the urinary system. It is one of the more common forms of cancer among men. It occurs about twice as often in men as women. It occurs after the age of 50 about 90% of the time.

Cancer of the bladder has one outstanding and readily detected sign—blood in the urine. Fortunately, this sign usually appears while the cancer is still in its early stages when it may be treated most successfully.

Most people with blood in the urine do not have cancer—urinary infections also may produce blood. But, it is an important warning sign that warrants investigation at the earliest possible moment.

Blood in the urine is not always a bright red color. If it is present in small quantities, the urine may appear to be merely "smoky" or "pink" in color. But any change from the usual appearance of urine should be investigated promptly.

Do not be misled if the bleeding occurs only once and then stops. It often appears intermittently; therefore, a single appearance warrants a visit to your doctor.

Cancer of the bladder usually is diagnosed by means of a cystoscope—a medical instrument with tiny lenses and a light which enables a physician to examine the interior of the bladder. The patient is given a mild anesthetic so that he/she is comfortable and without pain during the procedure.

A small piece of tumor is taken and submitted to a pathologist for examination to confirm a diagnoses. A urine test is also administered, and a microscopic examination is made.

Usually the cancer is controlled without surgery by scrapping the cancer out of the bladder or by implanting radon. Radon—a gas—is a cancer killing radioactive agent that has been extracted from radium. It is enclosed in a gold capsule and placed in the bladder.

Regardless of the treatment you receive, the earlier you see a doctor, the better are your chances for a cure.

Hints for New Urostomy Patients

Forwarded By ReRoute, Evansville, Indiana Chapter

Train yourself to shut the pouch valve as soon as you have emptied the pouch! If you forget, the resulting disaster within the next 10 minutes could ruin your day.

Be sure to take the plastic washbasin and clean measuring container home from the hospital. They are very helpful as you establish a daily routine of washing your nighttime equipment. Gallon bottles of white vinegar and cheap liquid detergent make the daily washing-up an inexpensive chore.

If you change the pouch first thing in the morning, there is less chance of the stoma misbehaving as you do the change.

Irrigate the pouch daily with a solution of 4/5 water and 1/5 vinegar. A five-quart paint pail with metal handle is a great night bottle container by the bed and also a safe way to carry this equipment to the bathroom in the morning.

The hospital plastic washbasin is an ideal container for supplies when traveling and can be used to hold the night drainage bag. In the morning, it is handy for washing-up wherever you are. It fits nicely into most carry-on bags and is not heavy.

In most cases, urostomy patients enjoy a completely normal diet. Cranberry juice, yogurt, or buttermilk will help combat urinary odors, and may help keep urine acidic which combats infections.

Tips for Urostomates

By Ben Hoover, Metro Maryland Ostomy Assn.

· Your equipment is not a handicap, it is a small nuisance. You can still do just about everything you ever did, although you might want to use an ostomy belt to hold your system is you are very active.

· Two or more pouch covers are one of the best comfort investments you can ever make. After all, that fluid is entering your pouch at 98.6°.

· People with a urostomy do not need to use stoma paste.

· The vinegar you use during the day in your night bag can ruin the plumbing in your home if it is not flushed or rinsed down with water.

· You are going to have some leaks. Do not worry about it. It happens to all of us. Just change your equipment and continue to march.

· Putting your night bag in a small plastic wash basin while in use will save on cleaning your rugs and floors.

· Some one-suit luggage will fit underneath an airline seat. A small plastic wash basin will fit in half of one side of the suitcase which will hold your supplies while traveling and is then available when you are using your night bag.

· Apply a little toilet paper to the drain on your pouch when you have drained the equipment to absorb the remainder of liquid residue out of the drain.

· Do not worry about your urostomy when traveling. You can go anywhere you want. You just have to take a few things you did not take previously.

· Take three times as many supplies as you think you will need when you travel ... just in case.

· If you have a leak in a pouch, put on a new pouch. If you have a leak in a barrier, put on a new barrier. Trying to use tape or fixing the leak will not work.

· There are many people out there that would love to trade their problems for what you and I will know only as an inconvenience.

Urinary Diversion:

Past, Present and Future

By Jerome A. Green, MD

Extraordinary advances in the field or urinary diversion have been made in the last twenty years. Presently, many methods of diversion exist. The evolution of urinary diversion is intriguing and has enabled superior treatment options for bladder disease.

The urinary tract consists of the kidneys, ureters—the tubes allowing urine to flow from the kidneys and into the bladder, a bladder, and a urethra—urinary outlet. Kidneys filter wastes, water and salts from the flood resulting in urine production. The bladder stores the urine until it is voluntarily emptied through the urethra and out of the body.

Urinary diversion, first described in 1852, is a surgical technique that diverts urine away from the bladder. The reasons for bypassing the bladder include: bladder cancer, disease, trauma, birth defects, and after bladder removal (cystectomy). Two broad categories of urinary diversion exist. A non-continent diversion is any isolated bowel segment (conduit) which allows urine to drain freely through the skin (stoma) called a urostomy. A continent diversion is a surgically created substitute for the bladder that is emptied naturally or with a catheter; e.g., continent urostomy, neobladder, ureterosigmoidostomy.

Almost every segment of the bowel or intestine has been used in the past for urinary diversion. The ileum, the end portion of the small intestine, is the most commonly used segment for urinary diversion due to technical ease and fewer metabolic side effects.

The type of diversion selected depends on a number of factors: age, general health, reason for diversion, manual dexterity, body shape, bowel disease, motivation for maintenance of body image, willingness to self-catheterize, tolerance of nighttime leaking, potential for recurrence of cancer, and prognosis of bladder disease. Regardless of the type, all diversions are associated with some short- and long-term complications, especially metabolic problems.

The oldest form of urinary diversion is ureterosigmoidostomy (U), which was first described by Smith in 1878. A U is a direct connection between the ureters and the lower large bowel or colon. Voiding or urination is via regular bowel movements. Over 60 different U techniques were reported by 1936. This was the method of choice until the 1950's when the metabolic effects and the development of secondary bowel cancers were discovered. These secondary cancers, located at the connection of the ureters and the colon, have been know to develop up to 26 years after the operation. This technique is still being used today for rectal reservoirs, however, cautiously as the long-term results are not available.

Although first described in 1911, the ileal conduit did not become the preferred method of urinary diversion until 1950. The technique of forming the ileal conduit has undergone very few changes since then. The operation is technically the simplest and one of the shortest compared to all other forms of urinary diversion. For a period of time, this was the only choice available to patients. Over the past two decades, advances have been made to develop other techniques, which eliminate the use of an external appliance. Currently, the ileal conduit remains the most popular method of urinary diversion due to its relatively few and infrequent complications.

The continent urostomy was first attempted in 1888, revised in the 1950's by Dr. Gilchrist, and successfully implemented in the 1980's. This type of diversion has a reservoir which collects and stores urine, and is emptied by inserting a catheter through a stoma located on the surface of the abdomen. Presently, there are more than 40 different types of continent urostomy diversions. Two popular stomal forms are the Kock pouch made entirely from ileum; and the Gilchrist—Indiana or Miami pouch—which is formed from the right side of the colon and a small segment of the ileum.

The stoma is designed for easy catheter insertion and must also be leak-free; i.e., continent. The continent urostomy requires a longer operation, necessitates a lengthier hospital stay, and results in a higher long-term complication rate. Long-term complications occur in approximately 15% of patients. The continent urostomy is not recommended for individuals who are of advanced age, have more severe cancer, decreased kidney function, or have had previous abdominal radiation therapy. Although the long-term results are not available, patient surveys have shown a better overall quality of life resulting from a continent urostomy as compared to the ileal conduit.

The neobladder became popular in the 1980's. The procedure involves replacing the diseased bladder with a bladder fashioned from intestine that empties through the urethra, the normal urinary opening. Careful patient selection is mandatory and is the key to success. similar to all continent diversions, there are many techniques and types available. After surgery, voiding or urinating becomes a new learned technique. Complete emptying of the neobladder may always require catheterization at the end of each void. Although the complication rates are higher, similarity to the natural voiding pattern translates into an improved quality of life compared to other forms of diversion. While long-term results are unavailable, the neobladder is currently considered to be the procedure of choice for selected patients with bladder cancer.

Not all types of diversion are suitable for every patient. There is no easy way to predict how each person will react to a particular type of diversion. However, research has shown that the selection of the most appropriate type of diversion, effective pre-operative counseling, and consulting with family members and other patients can help lead to a better quality of life.

In summary, there are several options for bypassing the diseased bladder: the ileal conduit, the continent urostomy, and the neobladder. Continuous research will shed light on the long-term effect of the different methods of urinary diversion. The future of urinary diversion looks bright. The next few decades will allow for the development of newer surgical reconstructive techniques, leading to lower complication rates and improved quality of life. The advent of gene cloning and tissue engineering will enable the growth of a new bladder. The ultimate goal of medicine is prevention. The prevention of bladder diseases is the key. We hope that in this millennium, the need for urinary diversion will hopefully be a thing of the past.

Tips & Hints

By The New Outlook, Chicago's North Suburban Chapter of UOA

· Urostomates should empty the pouch before it passes the half full level. There is a chance that the bag will pull away from it's seal if too heavy. There is also a chance of urine back-up.

· If you lose the small rubber washer on the drainage plug, it is reported that it can be replaced with a rubber hinge that is used to tighten eye glasses. If the washer on the urinary valve stretches, let it dry thoroughly.

· It may help to insert two ounces of a vinegar/water solution (1/2 cup of white vinegar to one quart of water) through the outlet valve of your emptied appliance twice daily, once in the morning and once at bedtime. Lie down for twenty minutes to allow the solution to "bathe" the affected area.

· Urostomates who do not use a night drain are running a big risk of puddling and the backing up of urine into the conduit up to the kidneys. This may cause not only irritation but serious infection.

· Check the pH of your urine about once a week to be sure the urine is acidic, with a pH of less than 6.0.

· Always wash your hands before working with your appliance or stoma, to avoid introducing bacteria into the stoma.

· Reusable or disposable appliances that are not cleaned adequately or are worn for long periods of time can cause urinary tract infections from bacterial growth in the pouch and urine.

· Signs and symptoms of a urinary tract infection include fever, chills, bloody urine, cloudy or strong-smelling urine, and pain in the back and kidney area. If you experience these symptoms, see your physician!

Urostomate & Fluids

By Juliana Eldridge, RNET

People with urinary diversions no longer have a storage area, a bladder, for urine. Therefore urine should flow from the stoma as fast as the kidneys can make it. In fact, if your urinary stoma has no drainage from even an hour, it is time for serious concern. The distance from the stoma to the kidney is markedly reduced after urinary diversion surgery. Any external bacteria have a short route to the kidneys. Since kidney infection can occur rapidly and be devastating, prevention is essential.

Wearing clean appliances and frequent emptying are vital. Equally important is adequate fluid intake, particularly fluids which acidify the urine and decrease problems of odor. In warm weather, with increased activity, or with a fever, fluids should be increased to make up for body losses due to perspiration and increased metabolism.

It is important that you be aware of the symptoms of a kidney infection:

· Elevated temperature

· Chills

· Low back pain

· Cloudy, bloody urine

· Decreased urine output

All ileal conduits normally produce mucus threads in the urine which give it a cloudy appearance. Bloody urine is a danger signal. Thirst is a great index of fluid needs. If you are thirsty, drink up. Also develop the habit of sampling every time you pass a drinking fountain.

Important…If urine is collected for urinalysis, called C&S, sterile specimen, checking urine for infection, etc., be sure your doctor and nurse know a sterile specimen must be taken directly from you stoma and not from the pouch. Bacteria builds up in the pouch immediately. It will give false test results.

If they are not sure how to do this do the following:

· Remove your pouch

· Clean the stoma

· Bend over

· Catch the urine in a sterile cup

If there is a slow flow of urine being expelled, drink a glass or two of water…the kidneys will work.

Urostomates

--Internet Sources

Most people who have urinary diversion surgery generally do not need to make special adjustments to their diets. However, if these people also have conditions, such as diabetes or heart disease, a change in diet would be prudent. The emotional trial of going through this type of major surgery should motivate everyone to maintain a healthy diet.

Urostomates must take special care not to gain too much weight because weight gain may precipitate some special problems. The stoma may retract as the flesh grows around it. This may happen due to the unique procedure used by the surgeon because of your particular anatomy. Some people gain weight and the relative position of the stoma never changes. But, with some, a retracted stoma will result. In addition, there is an increased chance of developing a peristomal hernia if there is too much pressure inside the abdomen due to being overweight.

Most people should perform regular exercise, like walking, soon after surgery to eliminate a laundry list of complications. Benefits include: reduced probability of blood clots and hernias, better healing, improved skin condition. Your physician will offer advise as to the extent you must exercise.

Normally urine is acid, and it is good to keep it acidic. This natural defense mechanism prevents growth of bacteria and the resultant infection. If the urine becomes alkaline, then the peristomal skin may develop granular, raised or warty areas which may be painful or reduce prosthetic adhesion. Alkaline urine may even cause crystal like encrustations or gray, plaque like lesions on the stoma. If such problems occur, the pH level of the urine should be checked to see whether it is acid or alkaline. Your ET nurse can do this for you.

To help make the urine more acidic there are some easy steps you may take. Drink 10 ounces of cranberry juice daily. (Cranberry juice is usually sold diluted. A concentration of over 30% cranberry juice is usually advised.) Also, vitamin C may be taken. Vitamin C as well as cranberry juice increase the acidity of urine. This will also reduce the probability of kidney stones in most people. Always check with your doctor to make sure there are no reasons to avoid these items. Vinegar soaks around the stoma may also be used for plaque encrustations or for raised tissue on or around the stoma.

Blue discoloration: Urostomates occasionally notice blue discoloration in the pouch or overnight drainage system. Be assured that there is nothing wrong with the appliance. In laboratory test conducted by ConvaTec, the blue color was found to be the result of normal bacterial decomposition of an essential amino acid called tryptophan.

There is no clinical evidence, according to an article in the American Journal of Nursing, to indicate that the production of indigo blue is harmful or that dietary tryptophan should be limited. If you are concerned, please talk with your doctor. Tryptophan is part of the regular intake of dietary protein. As it passes through your system it undergoes a series of chemical changes that ultimately result in a blue color when it finally oxidizes in the pouch.

One last issue, most urostomates require a convex faceplate. This will increase wear time and virtually eliminate leakage problems. Make sure there is some air in the pouch so the urine may easily run away from the stoma. A karaya barrier will melt when exposed to urine. Paste is also not advised because it may reflux into the conduit and cause infection. A belt will improve security when using a convex barrier.

Cautions for Urostomates

--Metro Maryland Newsletter

                                            `                                                     

People with urinary surgery generally do not need to be too concerned with diet unless they have some other health problems like diabetes or heart disease. The food eaten is passed the normal way. There is concern with how the kidney's will wash the liquids out of our systems.

They must however, take special care not to gain too much weight, since weight gain can precipitate some special problems. The stoma may retract as the flesh grows around it. This could cause your appliance to leak. And there's an increased chance of getting a hernia around the stoma if there is too much pressure inside the abdomen. Watching your weight is more important for ostomates than it is for non-ostomates. Stay fit.

Urostomates must drink enough liquid to keep the kidneys from overworking. If there is not enough liquid in our systems, the kidneys must work harder to clean out the harmful chemicals ingested into our systems. In fact, if the kidneys are working too hard, the liver must take over some of their job. You don't want to overwork your liver. It may lead to liver disease and end your life. Depending on your activities, the climate and how much you lose through perspiration, drink at least 64 ounces (two liters) daily. Only count water, clear fruit juice and herbal teas. Subtract caffeine drinks, alcohol and soda. When you drink these, you must make up the appropriate amount of water.

If you get a cold or flu, make sure you drink much more water. If you are not urinating, yet drinking a lot of water, then you are becoming dehydrated. Go to a hospital and have them put you on an IV. This will hydrate you, and you will be fine. This happens to a few of us at sometime

during our lives. Remember this just in case it happens to you.

Normally urine is acid and should be kept acidic. This natural defense mechanism prevents growth of bacteria and the resultant infection. If the urine becomes alkaline, raised, granular, warty areas can develop on peristomal skin which is constantly exposed to alkaline urine. Alkaline urine can even cause crystal-like encrustations or gray, plaque-like lesions on the stoma. If such problems occur, the pH of the urine should be checked to see whether it is acid or alkaline. In addition, alkaline urine may contribute to kidney stones.

To help make the urine more acid, vitamin C may be taken, after checking with your doctor to make sure there are no reasons to avoid it. Vinegar soaks around the stoma can also be used for plaque encrustations or for raised tissue on the stoma. Another way to keep your body acidic is to drink cranberry juice. You see, cranberry juice is an alkaline, but our bodies convert this to acid when it is absorbed. Drinking orange juice or many other acidic drinks or foods, convert to alkaline in our bodies creating the potential for kidney stones and other problems. Virtually the only way to purchase cranberry juice is in combination with something else. It is still good to use these drinks if the cranberry juice content is at least 35%.

Urostomy Change Procedures One

By Raymond Miller

Before I bathe or take a shower, and when I am not sweaty from exertion, I get a TV tray and a grocery bag for debris in a dry bathroom. I open the blinds to get the most light from the window. I use the two-piece system--ConvaTec Durahesive Natura wafers with a 1 1/2" flange, and pouches with the Accu-seal tap.  My stoma is 3/4" and I use a 1" convex insert.  Because I use a 3/4" hole cutter with a palm grip (Nu-Hope # 2526), I cannot see if I am exactly centered when I cut the hole. So I insert the 3/4" convex insert first, cut the hole, and replace that insert with the 1" insert. On the tray, I have a mirror on a 4" stand, 3 nappy washcloths, 3 wads of toilet paper, an adhesive remover (I use Bard's Adhesive and Barrier Film Remover #740020, but any would do including isopropyl rubbing alcohol), several 3x3" gauze patches, in case I need them ( I use Johnson & Johnson Nu-Gauze #7633, but cotton squares are fine), a wafer with the hole cut to the proper size,

and a pouch.

I stand in the tub, pull up the TV tray to the edge of the tub and place the grocery bag next to it. I remove the old appliance, and carefully remove any adhesive left on the skin from the old appliance with adhesive remover or alcohol.  I soap a wet piece of gauze, and thoroughly clean the area especially right around the stoma. I repeat soaking one of the washcloths in warm water, and squeezing the water over the stoma area several times, while using the other hand to gently rub the stoma area to be sure all the soap is removed.

I hold a wad of toilet paper over the stoma while drying the area around the stoma with the second washcloth, using both sides of the cloth. Finally, I use the third washcloth to finish the drying, using both sides until I can feel with my hand that the skin is thoroughly dry…dry…dry!   I change toilet paper wads as necessary, and dab the stoma dry.  I examine the stoma area carefully to be sure the skin is healthy after an extended wear time.  I bend over so that any urine coming out will fall straight down without getting on my skin.  If urine gets on the skin, I might as well start over.

I fix the mirror so that I am able to eyeball the stoma straight on to ensure centering the hole over the stoma.  I remove the backing from the wafer, and center the hole over the stoma, pressing and holding the wafer close around the stoma for a good seal.  While standing straight, I press the remaining wafer from inside to outside against the skin, and hold it there for a few seconds. I snap the pouch onto the wafer flange, making sure that it is securely fastened all around.  Sometimes I use the mirror to inspect under the pouch.  It's a good idea to hold the entire appliance against the skin for a while to get a good bond with the skin.

When showering starts to fray the upper edge of the wafer's collar, I apply a piece of tape across the top edge.  One-inch tape will do the job. Any "pink" or "hospital" tape will too.  I use Hy-tape.

Urostomy Change Procedures Two

By William Raymond Gantz

As a urostomate for 13 years, and being quite comfortable with my situation, it seems appropriate that I share some of my own procedures with others. I now change my prosthetic every six to eight days. It is usual for me to change on day seven. For some years, I had been able to get 14 days wear time during the temperate times of years, but several years ago, I started experiencing with reducing peristomal skin irritation, and now settle for the seven day average year round.

I perform my change cleanup in the shower, using a suitable chair for comfort and relaxation. I start the process as early as possible after draining and rinsing my night bag. The following are the procedures I use:

1. I remove the old pouch and wafer with the aid of ConvaTec AllKare Adhesive Remover wipes. I follow-up with the wipe to remove all traces of wafer material or adhesive.

2. I then wipe the peristomal area with a triple-square piece of folded toilet paper to dry as much adhesive remover from my peristomal area and from my fingers as possible.

3. I next wipe the peristomal area thoroughly with a fresh alcohol swab. I like the B-D brand.

4. I use another triple-square piece of toilet paper to dry the alcohol from the peristomal area.

5. If any long hairs are visible immediately around my stoma, I trim them carefully with a pair of baby scissors. About every four weeks, I carefully shave my peristomal area with the beard trimmer on my electric razor.

6. I begin my shower by washing my hands thoroughly with regular bath soap.   I next wash my peristomal area twice (okay, I'm being freakish) using only my hands and a bar of Neutrogena soap. The use of a neutral soap  was recommended to me by one of the consulting nurses at ConvaTec.

7. I take my regular shower, rinse, and dry my head, back, buttocks, and the back of my thighs. Then I bend my upper body and ripple my stomach muscles, and then message my peristomal area which often elicits the discharge of urine.

8. I turn on the shower again and hand wash my peristomal area with Neutrogena soap for the final time. If I haven't yet elicited a urine discharge, I will try once again before rinsing thoroughly to clean off the Neutrogena soap residue.

9. I dry my hands, and place a previously prepared slender, regular tampon in my stoma, rotating it back and forth gently so that a quarter inch or so penetrates into my stoma.

10. I hold the tampon in place with one hand while I finish drying with the other hand. I then move to the bed where I previously had placed a beach towel. I dry my peristomal area with a hair dryer set on cold with a low speed.

11. I hand the hair dryer to my wonderful wife who uses it on high to soften the adhesive on the wafer. I use ConvaTec wafers with convexity, and pouches with the Accu seal tap. I will be switching to Natura, ConvaTec informs me, but this is now reasonable because they offer the range of hole sizes in the wafer which they hadn't done previously.

12. On signal, I remove my finger from the tampon, and she carefully places the wafer whereupon I move the retaining finger back onto the tampon.   Upon the next signal, I remove the tampon, and she quickly presses the pouch onto the wafer flange, hopefully with a distinct click.

13. I press the flange against my abdomen to ensure maximum adhesion while she cuts a piece of pink tape which she places along the top edge of the picture frame tape on the wafer which otherwise turns down and picks up gnarr and smurgle during the week of wear.

I know that I have it really good, being married to such a wonderful woman. I can complete the change by myself, and have done so when my wife was elsewhere. However, so long as she, bless her, is willing, I will use her loving support.

This has been an elaborate, long-winded exposition, but it is my hope that someone, particularly newbies, will find portions that will assist them in learning how to get extended wear with their urinary prosthesis.

Urostomy Complications

Inside Out, The Edmonton Ostomy Chapter

Urostomates have a high incidence of complications, some occurring after 10 to 12 years. Most complications are gradual.    Probably the most common is caused by an ill-fitting pouch. Urine that accumulates on the skin around the base of the stoma may become reddish-brown with raised, thick, leather-like areas. It is important to have a faceplate or pouch opening that fits to within an eighth of an inch of the stoma to prevent this and other long term complications.

If the reddish-brown growth is extremely bad, it may be treated with soaks of white vinegar three times a day for three or four days. Vitamin C, taken according to directions on the bottle, may also be helpful to acidify the urine. Alkaline urine on the skin is irritating. If these measures are not successful, a revision of the stoma is an alternative.    Encrustation's or sand-like deposits on or around the stoma are another complication. When these deposits are noticed, start to increase your intake of cranberry juice. Vitamin C is also good, and your physician may order Mandelamine

to increase urine acidity even more. Orange juice is not recommended because of the high alkaline

ash residue.

One part vinegar to two parts water sloshed over the stoma helps if done once or twice a day. This encrustation can clog up the stoma and eventually cause a closure of the stoma. Recurrent urinary tract infections are prevalent in most urostomates. Most of you know the symptoms: fever, a strong urine odor, decrease output, amber-colored urine with a large amount of white sediment. You may need more fluids. You should be drinking at lease 64 ounces (two liter) of water each day. This will reduce infections and prevent kidney stones. Cleanliness is also important.

Urostomates should empty the pouch before it passes the half full level. There is a chance that the pouch will pull away from its seal because it is too heavy. There is also a higher chance of urine backing up into the conduit if the pouch if full.

Certain brands of pouches are effected by certain cleaning solutions. For instance: United Surgical's quality control laboratory has determined that using a vinegar and water solution to rinse United pouches changes the vinyl. They recommend their Uri-Kleen or Uni-Wash or other approved products to clean their appliances. Discuss this with your supplier.

The use of a small wastebasket at the side of the bed provides a handy storage place for your night drainage. unit. It also prevents kicking it over in the middle of the night. Also, when connecting your pouch to your night drainage container, do not completely empty your pouch. The collected urine will run down the tubing into the container and produce a siphon effect.

Urostomy Care

--Ostogram, Santa Clara, CA

Urinary appliances adhere well with: Durahesive or Flextend barriers; Stomahesive or Hollihesive barriers; Relia Seal, Colly Seals or barrier cement. The urinary stoma drains continuously. Urine will be irritating to the skin if it is in contact with it, and it may be odorous.

Often blood is noted in the appliance, and its origin is not immediately clear. One source may be irritation of the stoma by uric acid crystals formed in the appliance or on the skin around the stoma; e.g., when the faceplate is too large. This may be indicated by small white spots on the stoma upon removal of the appliance.

The crystals may be relieved by bathing the stoma and surrounding area with a half-strength vinegar solution three or four times a day while the appliance is being worn.

Many people change their appliance in the morning before having anything to drink. It is usually the most quiet before breakfast.

Only use drainable pouches with urinary stomas. Closed pouches should never be used.

Most urostomates have better results with convex appliances. Flat barriers have a tendency to leak around urinary stomas.

Two to four quarts of fluid intake daily should provide adequate "traffic" through the urinary system to prevent the increase of bacterial growth that occurs in a "slow moving" system. Increased bacterial growth may lead to urinary tract infections.

Karaya powder, karaya-glycerin washers and karaya barriers are usually ineffective in caring for the urinary stoma. Karaya will melt in urine, and the barrier is quickly washed away.

Urinary pouches allowed to get too full will leak. Connecting the pouch to a leg bag will be helpful if unable to empty often enough. Attach the strap of a leg bag loosely to allow good blood circulation.

A bedside drainage bag or bottle, similar to the type you probably used in the hospital, may be used for children and adults to prevent getting up during the night to empty the pouch. The average urinary pouch will not hold the amount of urine that may be excreted during the night.

Drinking cranberry juice has been found helpful in deodorizing urine. It also help keep the urine acidic to prevent a whole list of associated problems.

Urinary Ostomy

By Edith Lennebery, RNET—Town Karaya

The urinary ostomy requires three kinds of preventive attention:

· Care of the stoma

· Care of the skin around the stoma

· Care of the kidneys

Your routine care of kidney functions should include:

· Drinking > two quarts of liquids daily

· Testing urine (urinalysis) semi-annually

· Testing kidneys (IVP-intravenous phelogram) every two years

You should make the following observations:

· Changes in size of the stoma. After initial healing is complete—about six months—measure with a paper measuring gauge every few months; change to equipment with the correct opening if necessary.

· Appearance of stoma. Does it appear different from usual; e.g., color, shape, little white or red spots? Look for this at each change of appliance. See your ET nurse to determine if the change needs some action to repair.

· Skin … signs of irritation. Are there pink spots, tiny pimples, reaction to adhesives, etc.? Look for this at each change of appliance. Learn methods of treating routine minor irritations. If the are is sore, raw or infected, do not delay, see an ET. If there are white deposits around the base of the stoma soak your pouch in a 3:1 water: vinegar solution. If there is no improvement within two weeks, see your doctor.

· Kidneys. Look at your urine every day. Is it dark? Then drink more liquids. Is it gritty? See your doctor. Is there some mucus? This is normal. Is there a persistent unpleasant odor? This is a sign of infection, see your doctor.

Acidic Urine

--Metro Maryland

Very often, a person with a urostomy is advised not to drink orange juice, but is not given an explanation as to why. The rationale behind it actually applies to everyone at one time or another.

If you get a bladder infection, your urologist may give you the same admonishment, and for the same reason. Acidic urine tends to keep bacteria in check, thereby lessening the incidence of infection. Orange juice is not used by the body as an acid, but as an alkali. Alkaline urine also can cause crystal buildup around the stoma.

When the food that you consume is burned in the body, it yields a mineral residue called "ash". This ash can be acidic or base—alkaline—in reaction, depending on whether the food eaten contains mostly acidic or base ions.

The reaction of the urine can definitely be changed by foods like orange juice. Most fruits and vegetables actually give an alkalized ash and tend to make the urine alkaline. But there are some exceptions. Meat and cereals usually will produce an acidic ash that will acidify the urine.

Some acid-producing foods are breads—especially whole wheat, cheese, corn, crackers, cranberries, eggs, nuts, macaroni, pastries, rice, plums, prunes, meat, fish and poultry. Some alkaline-producing foods are milk, bananas, beans—lima and navy, beets, greens and spinach. Some neutral foods are butter, cream, honey, salad oils, syrups, sugar, tea and tapioca.

Normally, the urine in the bladder is acid in nature, so watch your diet. Nature know what she is doing.

Urinary Infections

--Kankakee Ostomy Association Newsletter

Germs are everywhere, but when they get in the urinary tract—conduit, ureters, or kidneys—they are in an abnormal environment, and that is what causes infection.

Infection of the kidneys is the most common long-term complication for urostomates. What causes infections? The reasons are mostly unexplainable; like, why some people get more colds than others.

Infections can be caused by kidney stones, obstructions, tumors, cysts and scar tissue. Infection is almost synonymous with the word obstruction, and then too often comes stone formation. It is sometimes an endless cycle.

Adequate hydration is first on the list for both treatment and prevention of infection. Generally, one needs a good flow of urine, much like a stream. This not only dilutes bacteria in the urine, but also helps wash it out. An average adult requires at least two quarts of liquid daily. Urostomates and ileostomates need more.

Antibiotics are used to fight bacterial infections. Therefore, the argument goes, why not give a patient with infections a strong antibiotic to be used indefinitely to prevent further infection? Most antibiotics will cause a resistance to develop over even a short period of time. Thus, very few—if any—antibiotics are suitable for long-term usage. Studies are being conducted to find particular drugs that have the ability to be used long term.

Urinary Diversions

By Norma N. Gill, ET

In the urinary diversion, we note certain thing that are traumatic to the patient. However, contrary to what most people think, urine on the skin does not cause a skin irritation except when it is trapped under the appliance.

Foolproof equipment is a must—no leakage. Yeast conditions are common; therefore, it is advisable to have a micro-granulated anti-fungal powder on hand whenever you see a reddened area. The removal of the adhesive disc—the barrier—again should be done gently pulling on the skin and not the appliance. This prevents one pulling off the cornified layers of skin. One can pull out the hair follicles by the roots which leaves the area wet and weepy if proper care is not taken.

Hair should be removed either by cutting with scissors or an electric razor. Never use a regular razor. It will shave off the roots of the hair. If one does have small weepy areas, they should be covered by a quality ostomy powder.

One must be re-measured after surgery for the right opening in the barrier, and if he/she isn't, we will see a crusty wart like looking skin, often bleeding, and oh, so tender. Then someone will cut a larger size opening to accommodate this. Wrong! It should be a smaller size to press down the "dishpan hands" skin. This is where skin has been exposed to urine so that it becomes water-logged. In some cases, one may have to go to surgery—for it is so tender—and have it shaved off to the skin level.

Then immediately, one must re-measure an exact sized barrier and check continually to make sure it is correct. Crystals are usually on the stoma, not on the skin. However, use of a full strength vinegar in the pouch, sloshed over the stoma once or twice a day will prevent this. Crystals show up as white deposits on the stoma. Again, let me stress for the urinary stoma—cements, pastes and adhesives cause problems. One must have a correct fitting barrier with proper adhesion.

However, skin problems are not as bad as those of the ileostomate. If one finds a re-action, use one of the high quality skin barriers around the stoma which will prevent this and provide a better seal.

Urostomy Care

Forward By Rose City Ostomy News

· The urostomate should keep in mind that the stoma may shrink for several months following surgery.

· It is important that your appliance fits well so that the skin around the stoma does not become thick and white due to contact with urine. This crust may rub against the stoma causing bleeding.

· Using paste with a urostomy is not advised because the residue from the paste can back-up into the conduit and even the kidneys causing infection.

· To cleanse the pouch of crystals, soak it in a solution of one-part vinegar to two-parts water.

· A glass of cranberry juice each day will help restore the acid level in your body. Taking Vitamin C also helps. An acidic body will result in less crystallization in your pouch and lower the risk of urinary infections.

· The urinary pouch should be emptied often; i.e., when the pouch is no more than about 1/3 full.

· There is no odor when the pouch is kept clean. Modern ostomy systems are odor-proof. If there is any odor noticeable when the system is closed, there is probably a leak somewhere that should be repaired. Of course, the inside of the pouch has the smell of urine, but should only be apparent when emptying the pouch in which case you smell like all other people.

· The portion of the intestine—usually the ileum—that is used to form the “conduit” is mucous forming. Thus, it is not unusual nor abnormal to see some mucous in the urine. This will appear as cloudy urine and is normal and healthy.

· Before attaching the night drain, leave sufficient urine in the pouch to fill the entire length of the tube. This eliminates air bubbles which prevent a flow through the tube and causes “back-up” issues. Filling the tube creates a vacuum from the pouch into the reserve, therefore, effectively draining the urine from the pouch to the night drain.

· For good results, you may want to change your appliance first thing in the morning before you eat or drink. Your stoma may not be as active at this time so as to give you some extra time to dry the peristomal skin and put the new ostomy system in place.

· Before you begin to change your ostomy system, bend over first. This will sometimes force out the remaining urine in your conduit offering you a few minutes of inactivity to complete the change.

Infection in Urostomies

Forward By Metro Maryland

Have you ever had a urinary infection? It can be most uncomfortable. You probably have no idea how you got it. Most urinary tract infections come from the ascending route—outside of the body—up the urethra, into the bladder, up the ureters and into the kidneys.

In the male, the length of the urethra is 6” to 8” long, and the antibacterial properties of prostatic secretion are effective barriers to urinary tract infection via this route. These two factors explain why males have a much lower incidence of urinary tract infections than do females.

The female urethra is about 1 ¼” long. The common onset of urinary tract infections for woman is at the time of marriage or following the initiation of sexual activity which points to the ascending infection via the urethra route.

Germs are all over the world, but when they are in the urinary tract, either in the conduit, ureters or kidneys, they are in an abnormal location and that causes an infection. Infection of the kidneys is the most serious long-term complication.

What causes infection? We really don’t know. Why do some people get more colds than others? Infections can be caused by an obstruction, kidney stones, tumors, cysts or scar tissue. Almost synonymous with obstructions, is infection, and then too often come stone formation. Once you have stone formation you can’t get rid of the infection. It’s kind of a cycle that goes ‘round and ‘round.

Infection can be caused by urine being forced back to the kidney through the conduit. This can be done by falling asleep with the appliance full of urine and then accidentally rolling over the pouch, causing urine to be forced back into the stoma through the urinary tract with tremendous pressure. Urine in the body is sterile, but once it goes into the appliance is becomes contaminated.

Treatment and Prevention:

1. Adequate hydration leads the list. In general, to prevent infection and to treat infection, you need a good flow of urine much like a stream. That not only dilutes the bacteria or germs in the urine, but also helps wash them out—2 ½ quarts of liquid daily is the minimum required for the average adult.

2. Antibiotic therapy: Antibiotics are used to fight infection for the short-term; why not put the patient on a strong antibiotic and leave him on it indefinitely to prevent further infection? Most antibiotics will cause some resistance to develop over a period of time. Plus, your body would be overcome with fungus—when bacteria if destroyed, fungus takes its place—which may become life threatening. There aren’t any antibiotics currently manufactured that should be used long-term for those reasons. Studies are being made to find a particular drug for this purpose, but so far nothing has been found that can be successfully used long-term.

Advice for Urostomates

Adapted By The New Outlook

· Keep all your ostomy equipment together in a regular area; i.e., a shelf in a closet or a cabinet. Make sure they are stored in a cool dry area.

· Always have extra supplies on hand. Reorder several weeks before you expect to run out in case of delivery or inventory issues.

· There are several factors that influence how long your ostomy appliance stays sealed. These include: weather, skin peculiarity, scars around the stoma, weight changes, diet, activity and the body shape near the stoma.

· Perspiration during the summer months will shorten the number of days between changes.

· Moist, oily skin may reduce adhesion time. You usually do not need to wash the skin around the stoma with soap. Plain water does nicely. Using alcohol or strong detergents to clean around your stoma may lead to itching and skin irritation.

· A new ostomate will invest much more time in changing his/her ostomy system. Once you gain confidence and experience, you can count on it taking about 10 minutes or less.

· You ostomy system should be changed on a definite schedule. Do not want for it to leak before you change it. Remember: You are in control. Pay attention to details and never rush.

· Ostomy systems should never be worn for more than seven days. Plus, if you are changing more than once daily, you need to make an appointment with an ET nurse.

· You alone can decide the best position for putting on your appliance. Sitting, standing or lying down is acceptable as long as it offers you the best view of your stoma and is the easiest to implement.

· Applying the pouch may be accomplished with greater ease if you change in the morning before you drink anything.

· Keep your ostomy system clean. Bacteria will multiply rapidly even in the tiniest droplet or urine outside of the body. Bacteria in the pouch may be able to travel back in through the stoma all the up to your kidneys causing an infection.

· Bacteria in the pouch may cause odor. Manufacturers sell special products to clean and disinfect appliances. Diluted vinegar may be used daily to rinse out the pouch.

· It is important to empty your ostomy pouch at regular intervals...at least every two to four hours and more if you drink a lot of fluids or wear a small pouch.

· Most urostomates benefit from using a convex ostomy system to eliminate leaking. Plus, make sure the system fits properly—as close to the stoma without touching it as possible. Peristomal skin exposed to urine suffers a multitude of problems if left untreated.

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