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

PURPOSE: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.