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:

1. Remove the old ostomy pouch and clean the stoma and surrounding skin.
2. Measure the stoma and cut the opening of a new skin barrier to fit snugly around it.
3. Apply barrier adhesive to the flange.
4. Attach the new pouch securely to the flange.
5. 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.