An ileal conduit--who takes care of the stoma?

Urostomy care requires manual skills and emotional adaptation. We identified predictors of self-stomal care and their impact on quality of life after urostomy creation in patients with an ileal conduit.

A telephone questionnaire was administered to patients treated with urostomy creation in 2005 to 2010. Assessment included demographic data, stomal care patient education data and quality of life parameters.

The study population included 65 patients, including 20% females and 80% males. Mean age was 72 years (range 40 to 88). Mean followup was 30 months (range 6 to 74). Of the patients 97% received stomal specific patient education preoperative but only 32 (49%) felt satisfactorily skilled in stomal care upon hospital discharge. Of the patients 34 (52%) self-managed the urostomy, including 85% of females but only 44% of males (p = 0.009). Predictors of long-term self-stomal care were patient perception that questions before surgery were answered (p = 0.04), better bag replacement training (p = 0.001) and early stomal care skill (p <0.001). Self-stomal care was associated with a higher quality of life score and an improved psychological impact score. On multivariate analysis female gender (OR 15.9, p = 0.008) and higher postoperative education score (OR 5.8, p <0.001) predicted self-stomal care. Preoperative education quality (β = 0.44, p <0.001) and self-stomal handling (β = 0.25, p = 0.02) predicted higher quality of life and an improved psychological impact score.

Only half of the patients with an ileal conduit care for the urostomy independently. Female gender, better patient education and early proficiency in stomal care predict long-term self-stomal care. An association exists between self-stomal care and improved quality of life.