A urostomy is a surgical procedure that creates an opening, called a stoma, on the abdomen to divert the flow of urine after the bladder has been removed or bypassed. The most common form is the ileal conduit, where a small segment of the intestine is used to create a channel for urine to exit the body. Since the flow of urine from the stoma cannot be controlled voluntarily, an external collection system is necessary. This system, often called an appliance or pouching system, consists of two main parts: a collection pouch and a skin barrier (wafer or flange), which adheres directly to the skin around the stoma to protect it from continuous urine exposure. The collection pouch attaches to the skin barrier and safely collects the urine.
Daily Management: Emptying the Pouch
Urine drains continuously into the pouch, making it necessary to empty the contents multiple times throughout the day. It is recommended to drain the pouch when it is approximately one-third to one-half full to prevent complications. For many people, this translates to emptying the pouch every two to four hours, depending on fluid intake and urine output.
Ignoring the need to empty the pouch allows it to become heavy, creating an uncomfortable pulling sensation on the skin barrier. This increased weight and tension can compromise the adhesive seal, raising the risk of leakage and premature appliance failure. Proper emptying involves using the drain valve or tap at the bottom of the pouch to release the urine into a toilet, followed by cleaning the outlet. At night, a small bedside drainage system can be connected to the pouch’s outlet to collect a larger volume of urine, which prevents the need to wake up for emptying and reduces the risk of urine reflux back toward the stoma.
Standard Schedule for Appliance Replacement
Determining the standard replacement frequency for the entire urostomy appliance focuses primarily on the wear time of the skin barrier. The skin barrier forms the protective seal against urine, which can cause skin breakdown if allowed to contact the skin. For most modern urostomy systems, the recommended wear time is between three and seven days. Consistent replacement within this window is advised to maintain a reliable seal and prevent the barrier material from degrading.
The type of system used influences the replacement routine, as appliances come in one-piece or two-piece designs. In a one-piece system, the pouch and the skin barrier are permanently joined, meaning the entire unit must be removed and replaced simultaneously. Conversely, a two-piece system features a separate skin barrier (flange) that remains on the body, while the collection pouch can be detached and replaced more frequently, sometimes daily. However, the flange itself must still be replaced every three to seven days to protect the skin and ensure the adhesive remains secure.
Establishing a consistent, routine schedule, such as changing the appliance every fourth or fifth day, is preferable to waiting for a leak to occur. While some manufacturers strive for a seven-day wear time, the average self-reported wear time for users is closer to five days. Factors like the product’s adhesive composition, body heat, and the characteristics of the individual’s skin all affect how long the barrier maintains its integrity. Regular replacement prevents the adhesive from becoming over-saturated, which can expose the skin to urine and lead to irritation.
Adjusting the Schedule: Recognizing When to Change Early
Despite the goal of a consistent schedule, certain signs indicate that the urostomy appliance must be changed immediately, even if the planned wear time has not been reached. The most significant indicator is leakage, meaning the protective seal has been compromised. Any visible seepage of urine under the edge of the wafer requires an immediate change to prevent damage to the delicate skin surrounding the stoma.
Warning signs also relate to the condition of the peristomal skin itself, often signaling a small, ongoing leak. The development of itching, burning, pain, or visible redness suggests the onset of peristomal dermatitis, requiring immediate removal and replacement of the system. The edges of the skin barrier may also begin to lift, curl, or erode, indicating that the adhesive is melting or breaking down. High levels of physical activity, excessive sweating, or immersion in water can accelerate this breakdown, necessitating a more frequent replacement schedule.