Definition
A ureterostomy is a surgical procedure where urine bypasses the bladder and exits through a stoma (opening) on the abdomen.
It is used for conditions like obstructive uropathy, high-grade reflux, or congenital anomalies affecting bladder function
Types
- Loop cutaneous ureterostomy or pyelostomy.
- End cutaneous ureterostomy.
Based on the number of ureters attached to the stoma and site of diversion, ureterostomy is divided into four types:
- Single ureterostomy: Only one ureter is brought to the surface of the abdomen.
- Bilateral ureterostomy: Two ureters brought to the surface of the abdomen, one on each side.
- Double-barrel ureterostomy: Both ureters are brought to the same side of the abdominal surface.
- Transureteroureterostomy: Both ureters are brought to the same side of the abdomen, through the same stoma.
Indications
- Obstructive uropathy unresponsive to lower urinary tract drainage.
- Obstruction requiring delayed surgical correction.
- High-grade reflux into a solitary kidney obstruction with infection.
- Poor bladder function secondary to a variety of congenital anomalies, including prune-belly syndrome, posterior urethral valves, bladder exstrophy, and urogenital sinus defect.
Equipment Needed
A tray should contain:
- Clean cloth.
- Soap.
- Skin wipers.
- Pair of gloves.
Procedure
| Aspect | Nursing Action | Rationale |
|---|---|---|
| Skin Protection | Clean the stoma area with mild soap and water; apply skin barrier creams. | Prevents irritation and breakdown due to constant urine exposure. |
| Stoma Monitoring | Observe for redness, swelling, or bleeding. | Early detection of complications ensures timely intervention. |
| Urine Drainage Management | Ensure the pouch is properly attached and emptied regularly. | Prevents leakage and maintains hygiene. |
| Preventing Infections | Use sterile techniques when handling the stoma and drainage system. | Reduces the risk of urinary tract infections. |
| Parental Education | Teach caregivers how to clean and maintain the ureterostomy. | Empowers parents to provide safe home care. |
Aftercare
- Place the child in a comfortable position and praise for cooperation.
- Clean and replace the articles and dispose the waste.
- Document the procedure.
Nursing Considerations
- Proper care of the pouch requires regular drainage and changing.
- Drain the pouch when it is between one-third and one-half full. This will be about every 2-4 hours or more often if the baby drinks a lot of feed.
- Change the pouch every 3-7 days or immediately if there is any leakage, remove the old pouch and apply the new pouch putting the sticky side to the skin and passing down to seal all edges.
- The stoma needs regular cleaning to prevent irritation caused by regular contact with urine, which has a high bacterial count.
- Wiping with a wet cloth while changing the bag will usually be enough.
- Soap is safe, but make sure to rinse well afterward.
- Use skin wipes or powder to protect the skin around the stoma, further and under the pouch barrier.
Complications
There is a risk for the baby to develop complications during surgery:
- Thrombosis.
- Embolism.
- Injury to adjacent structures.
- Cardiopulmonary complications.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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