Coping with an urostomy

In the case of a urostomy the urine flow is practically permanent, especially after drinking. In order to change your appliance the easiest way possible, avoid eating or drinking two hours prior to the installation of your appliance. When possible place your appliance in the morning.

• Wash your hands
• Place the following material on a towel: 

1. A new base plate and a new pouch if you are using a 2-piece system or a new pouch if you are using a 1-piece pouch and a bar of soap
2. A few wet compresses ( use water from the tap) 
3. A few dry compresses
4. A piece of thread (about 30 cm) (cotton tapestry style)

• Remove the used pouch from top to bottom while keeping your catheter in one hand to avoid it leaking. Follow the same procedure when removing your base plate (after having first removed the used pouch) in the case of a 2-piece system.
• Hold the catheter by the thread and fasten it to your abdomen with the microporous adhesives so that it cannot come off. 
• If there are long hairs around the stoma, cut it with clippers (avoid scissors and depilatory creams).
• Hold the catheter with one hand, and with the other one apply soap to the skin around the stoma, then rinse thoroughly. Carefully dry the skin (do not use a hairdryer; as it can cause burns). 
• It is possible to change the thread if it is wet or dirty. To do this, pull out the old thread and fasten the new thread as closely as possible to the skin, exactly in the same place, and make a knot
  (tie it tightly to avoid it sliding away, but be sure not to pinch the catheter!) 
• Place the thread against the skin so that it doesn't go over the dressing, which could detach the equipment. 
• Quickly pass the catheter into the support opening or the bag (don't cut it, because the size of the ureter corresponds to the precut opening) 
• Stretch the skin well (be sure there are no folds) before applying the support or bag on the thread. 
• The catheter can never pass into the anti-reflux system; it must stay in the upper part of the bag.

The exterior of the catheter can easily be cleaned with soap and water, but keep an eye on its fastening.

When your catheter is blocked, this can happen if you don't dring enough, it is necessary to rinse with sterile water, which only qualified personnel are able to do.

Is there any risk of contamination by the catheter?

If it does not pass through the anti-reflux system of the bag: no. That is, if it is placed in the upper part, the urine cannot flow back up into the kidney. On the other hand, if the catheter goes into the collected urine, there is nothing to prevent the urine from flowing into the kidney, leading to a kidney infection!

Note: It is very important not to inject anything at all into the catheter, especially non-sterile material! Your role will simply be to clean and change the equipment; everything to do with the catheter will be handled by qualified personnel.

Yes, the catheter can be blocked, if you don't drink enough. In this case your urine is salty, concentrated, has debris in it, and there can be hematuria (blood in the urine). You will see reduced flow and start to feel pain in your kidneys.

It is necessary to rinse with sterile water, which only qualified personnel are able to do.
 

Don't panic, but follow your normal routine and have it replaced without delay during an appointment with your urologist. Avoid drinking too much, because if urine is no longer collected your kidneys will dilate and become painful.

How often should the catheter be changed and who is in charge of it?

How frequently it is replaced depends on the type of material, but in general it should be every 4 to 6 weeks or even more. In any case, these changes are scheduled and you will be given an appointment.The catheter can be changed either by a surgeon, a doctor (stomatherapist), or a trained nurse.
 

When you return home, your stoma will look like a "greenhouse" strawberry because there is edema around it, but as the weeks pass (usually around two months), it will shrink in size, reaching its final size and shape (similar to a "wild" strawberry). You will need to adjust the collection based on the new dimensions (1 to 2 mm around the stoma).

Be careful not to confuse it with stenosis.
Stenosis of the stoma is an abnormal shrinking of its size (the skin starts to cover the intestine and you can only see just a single point and the urine always emerges under pressure, etc.). In this case you must immediately see a doctor because this is rare (for example, it may be due to the appearance of crystals in the urine).

These are complications specific to bladder bypass. The peristomal zone changes (a reddened, swollen, blemished appearance). These are hard, painful encrustations that close the stoma and can cause stenosis. Often due to insufficient drinking, the urine becomes infected, the pH is akaline (above 7), and there is a strong odor.

Treatment is as follows:

• Local: by bandaging with soaked compress (1/2 white vinegar and 1/2 water), for 5 or 10 minutes several times a day
• Covering wounds (verify collection, add peristomal paste)
• Reviewing care and equipment (2 parts, more frequent changes, etc)
• Consulting a doctor or stomatherapist.  

It is present in large quantities when you first have the Bricker procedure, giving the urine a 'snowy' appearance with deposits like egg white and a particular odor. This is normal, the intestinal segment is alive and continues to secrete mucus, which contains intestinal germs that are not harmful and should only be treated if there is a high fever and change in the person's condition. The mucus will decrease and sometimes disappear over a few months, but it can stay present, whether or not it is visible to the naked eye. 

This the total or partial external projection of the intestinal segment. It can be due to an accidental strain or happen spontaneously. Although unusual in appearance, it is not dangerous, but you mut be careful not to injure the intestine during care or with the equipment, and you should consult a urologist to proceed to a surgical correction. 

Around the stoma there sometimes appears a more or less pronounced projection that causes discomfort in the system (leakage) or esthetic problems (visible under the clothes). This is an 'eventration' which can be corrected by wearing a special 'stoma belt' or may require surgical correction. 

No, because cloudy urine dosen't necessarily indicate infected urine. The urine coming from a Bricker bypass is often cloudy due to the presence of mucus secretred by the intestinal tract. This produces a cottony, white deposit in suspension in the urine. A simple excess of mucus is enough to make the urine cloudy. However, urine can sometimes be "salty", concentrated and malodorous.

This can be due to:

• Insufficient hydration (you are not drinking enough)
• A possible infection, which can usually be avoided by good preventive care
• Urinary tract infection: The contamination of the urine is more frequent, because the catheter is a war of germs to enter. Regular changes of the catheter can reduce the risk.

Note: The presence of a catheter in the urether can under certain circumstances cause a violet color of the pouch. 

The simplest solution is to drink a glass of water regularly, so that you are drinking about 1.5 to 2 liters each day in addition to the water drank at meals.

These quantities must be increased in case of sweating or diarrhea. Alkaline urine can often be recognized due to its strong odor. To acidify it, you can drink prune or cramberry juice. To reduce odors, consider changing the pouch regularly, every 1 or 2 days. Always make sure you don't have a urinary tract infection. In the case of a Bricker bypass, mucus can also be responsible for odors. 

The emission of blood in the urine (hematuria) is a relatively frequent event that generally causes a lot of fear. Bleeding can be due to different causes, it is important to identify the cause in order to adopt the most effective treatment:

• Local origin: The most frequent and the simplest. This is bleeding of the stoma itself, due to the fragility of the mucosa, a wound, an ulceration or crystal deposits.
• Renal origin: Kidney stone, infection or a polyp can be the origin of blood in the urine. The ureterostomy catheter can also occasionally cause microtrauma to the renal papillae if it is onserted too far.
• Medicinal or food origins: Certain medicines or foods (such as beets) can color the urine.
• Anticoagulants can cause bleeding, which is why you must regularly check your coagulation level so that your doctor can adapt and calibrate your treatment.

In any case, don't panic, but don't hesitate to contact your stomatherapist or doctor, who will guide you and help you to find the cause and take charge of the problem.

Having a urostomy doesn ‘t mean that you have to follow a specific diet, eating must remain a pleasure. The best way of staying healthy is to have good food hygiene, try to eat regularly, slowly and calmly. Know that some foods can color urine (for example beets) or give them a specific odor (asparagus or cabbage).

One important rule is to drink a lot of water each day (between 1,5 liters to 2L). This is especially the case for a trans-ileal cutaneous urostomy where the output can contain mucus and therefore block catheters. Drink water to avoid having a blocage. You can drink coffee, tea, juices…. independently of your daily water consumption. You can drink alcohol in moderation. Be careful: plum juice or cranberry juice make urines more acid.

If you are invited to a meeting, a party or a dinner... with the right equipment you will be able to fully enjoy the event, as most venues have a bathroom, allowing you to empty your pouch when needed. In order for you to not have to empty your pouch too often, avoid drinking too much. If needed, you can also wear a leg pouch.