Name of the Procedure:

Ostomy Pouch, Urinary, with Standard Wear Barrier Attached, with Built-in Convexity (1 piece)
Common Names: Urinary Ostomy Pouch, Convex Ostomy Bag
Technical/Medical Term: HCPCS Code A4392 Ostomy Pouch

Summary

An ostomy pouch for urinary diversion is a medical device used to collect urine from a surgically created stoma—a small opening on the abdomen. The device is a one-piece system with a standard wear barrier and built-in convexity, which helps to secure the pouch and provide a better fit around the stoma.

Purpose

This device is used for individuals who have had a urostomy, a surgical procedure that creates an opening in the abdomen for urine to pass through. The ostomy pouch collects urine, helping patients manage urinary output effectively.

Indications

• Conditions warranting this device include bladder cancer, congenital defects, trauma, or severe bladder dysfunction.
• Ideal for patients who require a secure, leak-proof collection system and have a stoma that benefits from built-in convexity for a better seal.

Preparation

• Patients should follow their healthcare provider's instructions regarding diet or medication changes before use.
• No special diagnostic tests are required, but an initial consultation to ensure the correct fit and type may be necessary.

Procedure Description

1. Cleaning the Stoma: Clean the stoma and surrounding area with mild soap and water, ensuring the skin is dry.
2. Cutting the Barrier: Cut the barrier to fit snugly around the stoma, approximately 1/8 of an inch larger than the stoma.
3. Applying the Pouch: Remove the adhesive backing and gently apply the adhesive barrier to the skin, pressing it into place to ensure a secure fit around the stoma.
4. Securing the Pouch: Ensure the pouch is securely attached and there are no leaks. The built-in convexity should provide additional security for stomas requiring additional support due to their shape or location.

Duration

The application of the ostomy pouch takes about 10-15 minutes. The pouch itself can be worn for several days, depending on individual needs and wear.

Setting

This procedure can be performed at home by the patient or caregiver, or in a clinical setting for initial education and fitting.

Personnel

• Ostomy Nurses or Wound Care Specialists for initial fitting and education.
• Primary care doctors for ongoing management.

Risks and Complications

• Skin irritation or breakdown around the stoma.
• Leakage or detachment of the pouch.
• Rare allergic reactions to adhesive materials.
• Infection if the stoma area is not kept clean.

Benefits

• Effective management of urinary output.
• Improved quality of life with secure fit and leak prevention.
• Comfort and ease of use, allowing for routine lifestyle maintenance.

Recovery

• Patients can return to daily activities almost immediately after deploying the pouch.
• Regular maintenance and care of the stoma and pouch are necessary.
• Follow-up appointments to check on stoma health and fit of the pouch.

Alternatives

• Two-piece ostomy systems that separate the barrier from the pouch.
• Non-convex pouches for stomas that do not require additional support.

• Other urinary diversion options, such as indwelling catheters or continent urinary reservoirs.

  Pros: Easy application, fewer pieces to manage.
  Cons: May not be ideal for all stoma shapes and types.

Patient Experience

• Patients might feel anxious at first but typically find the process manageable with proper guidance.
• Pain or discomfort is generally minimal; however, skin irritation can occur but is manageable with proper care.
• Support from healthcare providers and ostomy support groups can be incredibly beneficial.