Ostomy pouch, urinary; for use on barrier with flange (2 piece), each
HCPCS code
Name of the Procedure:
Ostomy Pouch, Urinary; for Use on Barrier with Flange (2 Piece), each (A5073)
Common Name(s): Ostomy pouching, urinary appliance
Technical/Medical Term(s): Urinary ostomy pouch, urostomy pouch with flange
Summary
This procedure involves the use of a urinary ostomy pouch designed for attachment to a skin barrier with a flange. The device is part of a two-piece system where the pouch collects urine diverted from the bladder through a stoma, an opening created surgically on the abdomen.
Purpose
Medical Conditions or Problems It Addresses:
- Urinary diversion due to bladder cancer, spinal cord injury, congenital abnormalities, or severe bladder disease.
Goals and Expected Outcomes:
- To manage urinary diversion effectively.
- To ensure secure urine collection.
- To maintain skin integrity around the stoma.
- To provide comfort and maintain the patient's quality of life.
Indications
Symptoms or Conditions That Warrant the Procedure:
- Loss of bladder function.
- High risk of recurrent urinary tract infections.
- Chronic urinary incontinence unmanageable by other means.
- Prior cystectomy (bladder removal surgery).
Patient Criteria or Factors:
- Patients requiring permanent or long-term urinary diversion.
- Ability to manage the pouch system independently or with caregiver assistance.
Preparation
Pre-Procedure Instructions for the Patient:
- No significant preparation is typically needed for the application of a new ostomy pouch.
- Ensure the skin around the stoma is clean and dry.
Diagnostic Tests or Assessments:
- Regular follow-up with a healthcare provider to monitor stoma health and proper pouch application.
- Occasional assessment of kidney function and urinary health.
Procedure Description
Step-by-Step Explanation:
- Remove the old ostomy pouch and clean the stoma and surrounding skin.
- Measure the stoma and cut the opening of a new skin barrier to fit snugly around it.
- Apply barrier adhesive to the flange.
- Attach the new pouch securely to the flange.
- Ensure a proper seal to avoid leakage.
Tools, Equipment, or Technology Used:
- Ostomy pouch with flange.
- Skin barrier with adhesive.
- Ostomy scissors to cut the barrier.
- Adhesive remover and skin cleansers.
Anesthesia or Sedation Details:
- None required for routine pouch change.
Duration
- Pouch changes typically take around 15-30 minutes, depending on patient experience and any complications like skin irritation.
Setting
- Can be performed at home, in a hospital, or outpatient clinic.
Personnel
- Patients or caregivers trained in ostomy care.
- Ostomy nurses (enterostomal therapy nurses) for education and complex cases.
- Physicians for medical management of underlying conditions.
Risks and Complications
Common Risks:
- Skin irritation or infection around the stoma.
- Leakages due to improper sealing.
Rare Risks:
- Peristomal hernia (hernia around the stoma).
- Ulceration around the stoma site.
Management of Complications:
- Topical treatments for minor skin conditions.
- Consult ostomy nurse or doctor for severe issues.
Benefits
Expected Benefits:
- Effective management of urinary diversion.
- Enhanced quality of life due to secure and comfortable urine collection.
- Minimal disruption to daily activities.
Realization of Benefits:
- Immediate upon proper application.
Recovery
Post-Procedure Care and Instructions:
- Regular monitoring and care of the stoma.
- Ensure skin remains clean and dry.
- Change the pouch as needed, generally every 3-5 days or when leakage occurs.
Expected Recovery Time and Restrictions:
- No recovery period needed for routine changes.
- Regular medical follow-ups as scheduled.
Alternatives
Other Treatment Options:
- One-piece ostomy systems.
- Alternative urinary diversion methods such as ileal conduit or continent urinary reservoirs.
Pros and Cons of Alternatives:
- One-piece systems: Simpler but less flexible, may be harder to replace in case of leaks.
- Continent urinary reservoirs: No external pouch but require more complex surgery and maintenance.
Patient Experience
During the Procedure:
- Patients may feel minor discomfort or pressure during application.
After the Procedure:
- Typically experience relief from symptoms associated with urinary diversion.
- May have adjustments period to new pouching system.
- Pain management with over-the-counter analgesics if needed.
- Comfort measures include ensuring proper fit and regular monitoring for leaks or skin issues.