Urostomy Care: What Wound Care Clinicians Need to Know

For wound care clinicians, urostomy care requires more than knowing how to manage a pouching system. Unlike a colostomy or ileostomy, a urostomy diverts urine rather than stool, creating unique considerations for pouch selection, peristomal skin care, patient education, and ongoing assessment.

Whether you encounter a newly created urostomy in the acute care setting or a long-established urinary stoma during a wound clinic visit, understanding how a urinary diversion works can help you identify complications early, protect peristomal skin, and better support patients in managing their urostomy.

What is urostomy?

A urostomy provides a new route for urine to leave the body. The United Ostomy Associations of America (UOAA) explains that a urostomy is a surgically created opening (stoma) in the abdominal wall that allows urine to exit the body when the bladder has been removed or bypassed.

A urostomy may be necessary when the bladder has been removed or can no longer safely or effectively store and eliminate urine. According to the American Cancer Society, reasons for a urostomy can include bladder cancer, certain congenital conditions, neurological disorders affecting bladder function, and other diseases or injuries involving the urinary system.

An ileal conduit is one of the most common forms of incontinent urinary diversion. The surgeon isolates a short segment of the ileum to create a passageway for urine and reconnects the remaining bowel to restore intestinal continuity. The ureters are detached from the bladder and connected to the isolated ileal segment. One end of this segment is closed; the other is brought through the abdominal wall to create a stoma. Urine travels from the kidneys through the ureters, into the conduit, and out through the stoma into an external urostomy pouch. When a section of the large intestine (colon) is used instead, the diversion is called a colonic conduit. The American Cancer Society’s overview of urostomy types explains the two main categories — incontinent and continent — and how they differ in construction and control of urine output.

An incontinent urinary diversion does not have a sphincter that allows the patient to voluntarily control urine flow. With an ileal or colon conduit, urine drains continuously from the stoma, making an external pouching system necessary.

You may also encounter continent urinary diversions, which use intestine to create an internal reservoir that stores urine. In a continent cutaneous diversion, the reservoir has a continence mechanism that retains urine until the patient empties it intermittently using a catheter through a stoma on the lower abdomen or navel. A neobladder instead connects the reservoir directly to the urethra, allowing urine to leave through the urethra rather than an abdominal stoma. Neither type routinely requires an external collection pouch. Confirm the type of urinary diversion rather than assuming every patient uses an external pouch.

What should a healthy urostomy look like?

Assessment of the stoma should be part of routine urostomy care. A healthy urostomy stoma is generally pink to red and moist. Because the stoma is constructed from intestinal tissue, patients may also notice mucus in the urine or pouch. This is expected because the intestinal mucosa continues to produce mucus even after the segment of bowel has been repurposed as a urinary conduit.

Stoma size and shape can change during the postoperative period as edema decreases, so repeated measurement is particularly important following surgery.

Changes in stoma color deserve attention. A dusky, gray, brown, or black appearance may indicate compromised perfusion and requires prompt evaluation. You should also assess concerns such as excessive bleeding, retraction, prolapse, stenosis, mucocutaneous separation, and significant changes in urine output.

What is a urostomy bag or pouch?

A urostomy bag, more appropriately called a urostomy pouch, is a specialized collection system designed to continuously collect urine draining from the stoma.

The MedlinePlus guide to urostomy pouches and supplies, provided by the U.S. National Library of Medicine, explains the basic components of urostomy pouching systems and how patients use them. A properly fitted pouching system collects urine while helping maintain a secure seal and protect the surrounding skin.

Urostomy pouches generally have a drainable outlet or tap at the bottom so patients can empty urine without removing the entire system. They should also include an internal antireflux valve to help minimize the backflow of collected urine toward the stoma and the associated risk of pouch leakage. Many systems connect to a larger bedside drainage container at night to help prevent the pouch from becoming overly full while the patient sleeps. For newer products addressing everyday challenges such as leakage and discreet pouch emptying, see WCEI’s Buzz Report on the latest in ostomy care.

Patients may use either a one-piece or two-piece pouching system. With a one-piece system, the skin barrier and pouch are incorporated into a single unit. A two-piece system uses a separate skin barrier or wafer with a detachable pouch. Neither option is universally better. Selection should account for the patient’s abdominal contours, dexterity, visual ability, lifestyle, skin condition, and personal preferences.

Video: Urostomy care with Joy Hooper, RN, BSN, CWOCN, OMS, WCC, WCEI clinical instructor.

Why proper urostomy pouch fit matters for peristomal skin care

For clinicians who focus on skin and wound management, one of the most important aspects of urostomy care is maintaining a reliable seal.

Peristomal skin should ideally resemble the unaffected skin elsewhere on the abdomen. Persistent redness, denudement, itching, burning, or weeping should not simply be accepted as a normal consequence of having a urostomy.

A poorly fitting skin barrier can allow urine to contact the peristomal skin, contributing to moisture-associated skin damage and undermining adhesion. Once the skin becomes moist and damaged, obtaining a reliable pouch seal can become even more difficult, creating a cycle of leakage and additional skin injury. The goal is to have the skin barrier opening fit closely around the base of the stoma to minimize unnecessary exposure of peristomal skin while avoiding injury to the stoma itself.

Assess peristomal skin complications in patients with urostomy

When peristomal skin breakdown occurs, wound care clinicians should resist the temptation to treat the skin without investigating why the damage developed.

Look at the entire pouching system and abdominal profile. Is urine undermining the barrier? Has the stoma become flush or retracted? Are there creases, folds, scars, or changes in body contour affecting the seal? Is the patient experiencing frequent leakage? Has weight gain or loss changed the abdominal surface?

The location and pattern of skin damage can provide valuable clues and help guide adjustments to the fit. Note where it sits relative to the stoma and the edge of the barrier, and whether it follows creases, folds, or scars, since these patterns can point to leakage under the barrier, a poor fit, or changes in body contour. When removing the pouching system, inspect the adhesive side of the skin barrier for urine undermining, erosion, or uneven breakdown.

Also remember that not every peristomal rash is caused by urine. Depending on the clinical presentation, clinicians may need to consider mechanical injury from repeated adhesive removal, irritant or allergic contact dermatitis, folliculitis, fungal involvement, or another dermatologic condition.

Persistent or unexplained peristomal skin problems are an excellent reason to involve a Wound, Ostomy and Continence (WOC) nurse or another qualified ostomy specialist.

Patient education for successful urostomy care

Successful urostomy management extends beyond choosing the right pouch.

Patients and caregivers need to understand how to empty and change the pouching system, assess the stoma, recognize leakage, and monitor the surrounding skin. They should also know which changes require professional evaluation.

The UOAA guide “Living With a Urostomy” is a useful resource clinicians can share with patients who need additional information about routine care and warning signs.

Teaching should begin early and be reinforced over time. For a patient facing a new urostomy, the equipment, terminology, and physical changes can initially feel overwhelming. Breaking education into manageable steps — and giving patients opportunities to participate in their own care — can help build independence and confidence.

You should also normalize appropriate questions about clothing, sleep, travel, work, exercise, intimacy, and body image. Living with a urostomy involves much more than managing an appliance.

Keep peristomal skin assessment on your radar

Even when a patient presents to the wound clinic for an unrelated wound, take advantage of the opportunity to ask about their urostomy when appropriate.

Simple questions can uncover problems patients may not realize warrant attention. Ask: “Are you having any leakage?” “How often are you changing your pouch?” and “Have you noticed burning, itching, or changes in the skin?”

For wound care clinicians, that makes the urostomy more than an appliance to work around. It is another important area where careful assessment, prevention, patient education, and early intervention can make a meaningful difference in day-to-day care.