Ureterostomy is a surgical procedure in which the urine bypasses the bladder and exits the body through a surgically created opening (stoma) and collects into a pouch that is worn outside the body.
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
Common Challenges
- Yeast rash: Use antifungal cream (e.g., clotrimazole) if red, raised rash appears.
- Stoma bleeding: Mild bleeding is normal post-op; persistent bleeding needs evaluation.
- No urine output: Try warm compresses; if unresolved, seek immediate medical attention.
Equipment Needed
- Perform hand hygiene and gather supplies:
- Clean cloth or baby wipe
- Mild soap (if needed)
- Skin barrier wipes or powder
- Pediatric urostomy pouch
- Gloves
Procedure
- Open the pouch valve and empty urine into a container or diaper.
- Remove the old pouch gently, supporting the skin to avoid trauma.
- Clean the stoma and surrounding skin with warm water or mild soap. Avoid scrubbing.
- Dry the area thoroughly—moisture can cause skin breakdown.
- Apply skin barrier (wipe or powder) to protect peristomal skin.
- Attach a new pouch, ensuring a snug fit around the stoma to prevent leakage.
- Secure the pouch and check for proper adhesion and comfort.
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 child drinks a lot of fluids.
- 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.
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
- 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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