Urostomy Urine Sample Collection

Understanding Urostomies and Urine Sample Collection

A urostomy (also called an ileal conduit) is a type of urinary diversion surgery where a segment of the ileum (small intestine) is used to create a passageway (conduit) that allows urine to drain from the kidneys to the outside of the body through an abdominal stoma. Unlike the bladder, a urostomy provides no storage capacity—urine drains continuously into an external collection pouch worn over the stoma.

Obtaining an accurate urine sample from a patient with a urostomy requires specific technique to ensure the specimen is not contaminated by bacteria colonizing the appliance or external environment. The clean-catch method during appliance change is the gold standard for collecting diagnostically useful urine samples.

Primary Purpose

Obtain sterile urine sample from urostomy for urinalysis and culture without contamination from pouch bacteria

Collection Method

Clean-catch technique during appliance change (preferred) or catheterization by trained personnel (only when necessary)

Critical Principle

Never sample from pouch – urine in appliance is contaminated and unsuitable for diagnostic testing

Sample Volume

10-20 mL for urinalysis
5-10 mL for culture (check lab requirements)

🎯 Why Proper Collection Technique Matters

Prevent false-positive cultures: Urine from the pouch is colonized with bacteria and will give misleading results
Ensure diagnostic accuracy: Fresh urine directly from the conduit reflects actual urinary tract status
Avoid unnecessary treatment: Contaminated samples lead to inappropriate antibiotic use
Reduce patient harm: Improper catheterization can perforate the delicate ileal tissue
Maintain appliance integrity: Coordinating with scheduled changes minimizes skin trauma

Common Indications for Urostomy Surgery

Bladder cancer requiring radical cystectomy (bladder removal)
Neurogenic bladder with recurrent infections and renal damage
Severe bladder dysfunction from radiation injury or interstitial cystitis
Congenital abnormalities of the urinary tract
Trauma with irreparable bladder damage
Palliative diversion for advanced pelvic malignancies

Why Urine from the Pouch Cannot Be Used for Testing

🚫 Critical Principle: Never Sample from the Pouch

Urine that has been sitting in the ostomy appliance is contaminated and unsuitable for urinalysis or culture. The pouch environment promotes bacterial growth from skin flora, air exposure, and appliance materials. These colonizing bacteria do not represent infection—they are normal contaminants that will cause false-positive culture results.

What Makes Pouch Urine Unacceptable?

Bacterial colonization: Appliances become colonized within hours of application, even with proper hygiene
Extended contact time: Urine sits in the pouch for variable periods, allowing bacterial multiplication
Temperature effects: Warm body temperature accelerates bacterial growth in stagnant urine
Mucus contamination: The ileal conduit produces mucus that mixes with urine in the pouch
Environmental exposure: Air enters the pouch during emptying, introducing additional contaminants

Acceptable Collection Methods

✅ Clean-Catch During Appliance Change (Preferred)

Collect fresh urine directly from the stoma into a sterile container immediately after removing the appliance and cleaning the stoma. This is the gold standard for routine urine collection.

⚠️ Catheterization (Only When Necessary)

Reserved for situations where clean-catch is impossible or when the specimen must be absolutely sterile. Should only be performed by trained personnel due to perforation risk. Not recommended for routine use.

Essential Equipment for Urostomy Urine Sample Collection

PPE: Non-sterile gloves, plastic apron, consider eye protection if splash risk

New ostomy appliance: Appropriate size and type for patient’s stoma (one-piece or two-piece system)

Measuring guide/template: To accurately measure stoma diameter

Scissors: For cutting appliance opening to fit stoma

Adhesive remover spray/wipes: To gently remove existing appliance

Cleaning supplies: Warm water, gauze or soft cloth, basin

Skin protection: Protective film, barrier wipes, seals and washers as needed

Sterile sample container: Labeled with patient information

Protective pad: To protect patient’s clothing and bedding

Jug or receiver: For existing pouch contents

Disposal bag: For used appliance and waste materials

💡 Equipment Preparation Tips

Have all supplies within reach before starting—you cannot leave the patient once the appliance is removed. Warm the new appliance by holding it in your hands or placing it on a heating pad (low setting) for better adhesion. Pre-cut the appliance opening if the stoma size is established. Keep the sample container easily accessible but protected from contamination.

Step-by-Step: Obtaining Clean-Catch Urine from a Urostomy

1Patient Preparation and Consent

Identify the patient using two unique identifiers (name and date of birth or medical record number)
Introduce yourself, explain the procedure in clear terms, and obtain informed consent
Explain that urine collection will be coordinated with an appliance change
Assess patient’s understanding and address any concerns or questions
Ask about usual appliance change routine and any special products used

2Position Patient for Optimal Access and Visualization

Ensure the patient is in a comfortable position—semi-recumbent or supine is often best
Position allows good visualization of the stoma and comfortable working height for the nurse
If the patient is able and wishes to observe, position a mirror or ensure clear line of sight
Provide privacy with curtains or closed doors while maintaining good lighting
Place a protective pad under the patient to catch any drips or spills

3Perform Hand Hygiene and Apply PPE

Wash hands thoroughly with soap and water or use alcohol-based hand rub
Apply non-sterile gloves and plastic apron
Consider eye protection if splash or spray is anticipated

4Empty and Remove Existing Appliance

Empty the contents of the pouch into a jug or measuring container before removing
This makes the appliance easier to handle and reduces spillage risk
Apply adhesive remover spray/wipes to the appliance edges
Gently peel the appliance away from the skin with one hand while supporting the skin with the other
Work slowly to minimize skin trauma and patient discomfort
Fold the used appliance in half (adhesive sides together) to prevent leakage
Place in a disposal bag immediately

5Assess Stoma and Peristomal Skin

Examine the stoma for:
- Color: Should be red to dark pink (like the inside of the mouth)
- Size and shape: Note any changes from previous assessments
- Height: Protruding, flush, or retracted
- Integrity: No bleeding, necrosis (black/purple tissue), or stenosis (narrowing)
- Output: Presence of mucus (normal), blood (abnormal), or purulent drainage
Examine the peristomal skin for:
- Redness, irritation, or breakdown
- Excoriation from urine contact
- Skin folds or irregularities affecting appliance fit
- Signs of infection or allergic reaction to appliance adhesive
Document any abnormal findings and report to the ostomy nurse or physician

🚨 Emergency Findings – Stop and Notify Physician Immediately

Stoma necrosis: Black, purple, or very pale stoma (indicates compromised blood supply)
Significant bleeding: Active bleeding from stoma (small amounts of blood are common with manipulation)
Prolapse: Stoma protruding excessively beyond normal height
Severe stenosis: Stoma opening significantly narrowed or difficult to visualize
Suspected bowel obstruction: No urine output, severe abdominal pain or distension

6Clean the Stoma and Peristomal Area

Soak gauze or soft cloth in warm water (not hot—test temperature first)
Gently clean the stoma and surrounding skin using a dabbing or wiping motion
Do not use alcohol-based or harsh antiseptic solutions—these can irritate the mucosa
Remove any mucus, dried urine crystals, or debris
Clean outward from the stoma to avoid introducing contaminants toward the opening
Use fresh gauze for each wipe to prevent recontamination

7Collect the Urine Sample

Open the sterile sample container but keep the lid nearby to avoid contamination
Position the sample container directly below the stoma opening
Wait patiently for fresh urine to drip from the conduit into the container
Do not squeeze, press, or manipulate the stoma to force urine output—this can cause trauma
Urine may drip immediately or may take 1–2 minutes to begin flowing
Collect at least 5–10 mL for urinalysis and culture (check your lab’s minimum requirements)
If urine flow is slow, gently encourage the patient to cough or take a deep breath (increases intra-abdominal pressure)
Once adequate sample is obtained, cap the container immediately

⏱️ Timing and Patience

Urine flow from an ileal conduit is continuous but variable. The rate depends on hydration status, time since last voiding, and individual anatomy. It’s normal for collection to take 2–5 minutes. Do not rush or attempt to speed the process by manipulating the stoma.

8Dry the Peristomal Skin Thoroughly

Pat (do not rub) the peristomal skin and stoma dry with clean gauze
Ensure skin is completely dry—moisture prevents appliance adhesion
Pay special attention to skin folds and creases where moisture collects
The stoma itself will remain moist (this is normal), but the surrounding skin should be dry

9Apply Skin Barrier Products (If Indicated)

If peristomal skin is irritated or prone to breakdown, apply protective barrier film, spray, or wipe
Allow barrier products to dry completely before applying appliance (usually 30–60 seconds)
Apply paste, seals, or washers to fill in skin irregularities and create a level pouching surface
Convex appliances may be needed for retracted or flush stomas

10Measure Stoma and Prepare New Appliance

Use a measuring guide or template to determine the stoma’s current diameter
Stomas change size over time, especially in the first 6–8 weeks post-surgery
Cut the appliance opening approximately 3 mm (1/8 inch) larger than the stoma diameter
This clearance prevents trauma to the stoma while protecting skin from urine exposure
Smooth any rough edges after cutting to prevent stoma injury
Warm the appliance adhesive in your hands for better adherence

11Apply New Appliance

Remove the backing from the appliance adhesive
Center the opening over the stoma, visualizing to ensure proper alignment
Gently press the appliance onto the skin, starting at the bottom and working upward to avoid trapping air
Apply firm, even pressure around the entire adhesive surface for 30–60 seconds
Body heat activates the adhesive, so holding pressure improves seal
Ensure the pouch drains downward and is easily accessible for emptying
Attach pouch to two-piece baseplate if using a two-piece system

12Clean Up and Complete Documentation

Dispose of all used materials in appropriate waste containers per facility policy
Remove gloves and apron and perform hand hygiene
Label the sample container at the bedside with patient name, date, time, and collection method
Place labeled specimen in a biohazard bag with completed requisition form
Transport to laboratory promptly or refrigerate if delay is unavoidable

13Document the Procedure

Date and time of appliance change and sample collection
Stoma appearance: color, size, height, and condition
Peristomal skin assessment and any interventions performed
Type and amount of urine collected
Patient tolerance of the procedure and any concerns
Type of appliance applied and products used
Specimen sent to laboratory with requisition

Troubleshooting Common Issues

Problem	Possible Cause	Nursing Actions
No urine flow from stoma	Dehydration, recent voiding, obstruction, or patient anxiety	Wait 2–5 minutes patiently. Have patient cough or take deep breaths to increase intra-abdominal pressure. Ensure patient is well-hydrated (offer fluids if appropriate). If no urine after 5–10 minutes and patient reports decreased output, assess for obstruction and notify physician.
Urine spraying or difficult to collect	Protruding stoma, patient movement, or high urine flow rate	Position sample container as close to stoma as possible without touching. Use a wider-mouth container. Have assistant help stabilize patient or container. Consider collecting during a time when urine flow is typically slower.
Stoma appears retracted or flush with skin	Normal anatomy variation, weight gain, or stoma retraction complication	Gently apply pressure around the stoma base to encourage protrusion (do not press on stoma itself). Use convex appliances for ongoing management. Consult ostomy nurse specialist if retraction is new or worsening—may require surgical revision.
Peristomal skin breakdown or irritation	Urine contact, poorly fitting appliance, allergic reaction, or fungal infection	Allow extra drying time. Apply protective skin barrier products. Ensure appliance opening is correctly sized (not too large). Consider antifungal powder for suspected yeast infection. Consult wound/ostomy specialist for persistent issues. May need different adhesive or appliance brand.
Excessive mucus in urine sample	Normal ileal secretion—intestinal tissue produces mucus	This is expected and normal. The ileum continues to produce mucus even when repurposed as a conduit. Note the presence of mucus on the lab requisition. Do not attempt to remove mucus from sample as this represents the patient’s actual urine composition.
Patient anxiety or embarrassment	Body image concerns, unfamiliarity with stoma care, cultural sensitivities	Provide privacy and maintain professional demeanor. Explain each step before performing it. Involve patient in care as able and willing. Offer to cover areas not currently being worked on. Connect with ostomy support groups. Arrange ostomy nurse specialist consultation for ongoing education and emotional support.
Appliance won’t adhere properly	Moisture on skin, skin products (lotions/oils), poor skin turgor, excessive sweating	Ensure skin is completely dry—use hair dryer on cool setting if needed. Remove any residual adhesive remover with water. Avoid lotions or oils on peristomal area. Use barrier rings or paste to level irregular skin. Consider belt for extra security. May need different adhesive formula for perspiration or humidity.
Bleeding from stoma during cleaning	Stoma tissue is highly vascular and friable; minor bleeding common with manipulation	Small amounts of bleeding are normal—stomal mucosa bleeds easily but stops quickly. Apply gentle pressure with gauze. If bleeding is profuse, persistent (>5 minutes), or accompanied by other symptoms, hold pressure and notify physician urgently.

Nursing Care Plans for Urostomy Management

Care Plan 1 – Patient with New Urostomy (Post-operative Period)

Example Nursing Problems

Deficient knowledge regarding urostomy care and appliance management
Disturbed body image related to presence of urostomy
Risk for impaired skin integrity related to continuous urine drainage

Goals / Expected Outcomes

Patient will demonstrate correct appliance changing technique before discharge
Patient will verbalize acceptance of body changes and identify coping strategies
Peristomal skin will remain intact without breakdown or infection
Patient will recognize signs of complications and when to seek help

Key Interventions (Selected)

Begin ostomy education as soon as patient is physiologically stable and receptive
Encourage patient to observe and participate in appliance changes progressively
Use positive language; avoid terms like “deformity” or “handicap”
Assess stoma and peristomal skin with every appliance change
Teach proper cleaning, measuring, cutting, and application techniques through demonstration and return demonstration
Provide written materials, diagrams, and video resources
Connect patient with ostomy support groups and peer visitors if desired
Arrange follow-up with ostomy nurse specialist after discharge
Ensure patient has adequate supplies and knows how to order more

Care Plan 2 – Risk for Urinary Tract Infection with Urostomy

Example Nursing Problems

Risk for infection related to stagnant urine in collection system and bacterial colonization

Goals / Expected Outcomes

Patient will remain free from UTI signs (fever, flank pain, foul-smelling urine, increased mucus)
Urine will remain clear to slightly cloudy with normal mucus content
Patient will maintain adequate hydration (30 mL/kg/day unless contraindicated)

Key Interventions (Selected)

Empty pouch when 1/3 to 1/2 full to prevent backflow into stoma
Rinse pouch with water or mild vinegar solution between changes to reduce bacterial growth
Change appliance on regular schedule (1-piece: 1-3 days; 2-piece: every 3-7 days)
Encourage fluid intake to 2-3 L/day unless contraindicated—dilute urine reduces bacterial concentration
Teach patient to recognize UTI symptoms: fever, flank/back pain, cloudy/foul-smelling urine, increased mucus, malaise
Monitor for changes in urine color, clarity, or odor
Vitamin C or cranberry supplementation may acidify urine (though evidence is limited; consult physician)
Ensure proper hand hygiene before and after ostomy care
If UTI suspected, collect clean-catch urine sample for culture before starting antibiotics

Care Plan 3 – Impaired Skin Integrity Around Urostomy

Example Nursing Problems

Impaired skin integrity related to urine contact, adhesive trauma, or appliance leakage

Goals / Expected Outcomes

Peristomal skin will show healing within 5-7 days of intervention
Patient will remain free from pain or burning at ostomy site
Appliance will adhere for expected wear time without leakage

Key Interventions (Selected)

Assess peristomal skin at every appliance change using consistent grading tool
Identify cause of breakdown: urine contact (incorrect sizing), mechanical trauma (poor removal technique), chemical irritation (adhesive allergy), infection (candidiasis)
Apply skin barrier powder to weeping areas; dust off excess; seal with barrier film
Ensure appliance opening is correctly sized—measure stoma at every change initially
Use adhesive remover and gentle technique when removing appliance
Allow skin to air-dry completely before applying new appliance
Consider convex appliance if stoma is retracted or flush with skin
Use barrier rings or paste to fill skin irregularities
For suspected candidiasis: apply antifungal powder, dust off excess, seal with barrier
Consult ostomy nurse specialist for persistent or worsening skin issues
Document skin condition, interventions, and response with each assessment

Care Plan 4 – Patient Education for Urine Sample Collection at Home

Example Nursing Problems

Deficient knowledge regarding proper urine sample collection technique from urostomy

Goals / Expected Outcomes

Patient will correctly describe the clean-catch technique for urine collection
Patient will understand why pouch urine cannot be used for testing
Patient will be able to coordinate sample collection with routine appliance change

Key Interventions (Selected)

Explain the difference between colonizing bacteria in the pouch and actual urinary tract infection
Teach that urine must be collected fresh from the stoma during appliance change
Demonstrate clean-catch technique: remove appliance, clean stoma, collect fresh urine in sterile container
Emphasize not squeezing or manipulating the stoma to obtain urine
Teach proper sample labeling and transport (refrigerate if cannot be delivered within 1 hour)
Provide patient with extra supplies (sterile containers, adhesive remover) for home collection
Review signs of UTI that would necessitate sample collection: fever, flank pain, foul odor, increased mucus
Ensure patient knows how to contact physician’s office or lab for instructions
Arrange for home health nursing if patient unable to perform technique independently

❓ Frequently Asked Questions (FAQ)

1. Why can’t we collect urine from the urostomy pouch itself?

Urine that has been sitting in the pouch is contaminated with bacteria from the appliance and air exposure, making it unsuitable for accurate urinalysis or culture. Clean-catch sampling requires fresh urine directly from the stoma to ensure the sample reflects the actual urinary tract status rather than pouch colonization.

2. What is the difference between a urostomy and a colostomy?

A urostomy (ileal conduit) is a urinary diversion created from a segment of ileum to drain urine from the kidneys to the outside of the body. A colostomy is a fecal diversion that brings the colon through the abdominal wall to eliminate stool. Urostomies drain urine continuously and require specialized collection techniques, while colostomies eliminate formed or semi-formed stool.

3. How often should a urostomy appliance be changed?

One-piece appliances are typically changed every 1-3 days, while two-piece systems allow the baseplate to remain in place for 3-7 days with only the pouch being changed as needed. Change frequency depends on adhesive integrity, leakage, skin condition, and patient preference. The appliance should always be changed if leaking or if the seal is compromised.

4. Can urostomy patients catheterize their stoma for a urine sample?

Catheterization of a urostomy stoma is generally not recommended and should only be performed by trained healthcare professionals when absolutely necessary. The ileal segment is delicate and easily perforated, and catheterization increases infection risk. Clean-catch technique during appliance change is the preferred method for routine urine collection.

5. What should I do if the stoma appears retracted or flush with the skin?

Retracted or flush stomas make urine collection more challenging. Use convex appliances to help the stoma protrude, consider gentle stoma manipulation to encourage urine flow, and have the sample pot ready immediately upon appliance removal. If retraction is severe or new, consult with the ostomy nurse specialist as this may indicate complications requiring intervention.

6. How can I tell if the peristomal skin is healthy?

Healthy peristomal skin should be intact, similar in color to surrounding abdominal skin, and free from redness, irritation, or breakdown. The stoma itself should be moist, red to pink in color (like the inside of the mouth), and slightly raised above the skin. Report any skin breakdown, severe redness, bleeding, unusual discharge, or stoma color changes (purple, black, or very pale).

7. Why do we measure the stoma before cutting a new appliance?

Stomas can change size over time due to weight fluctuations, swelling, or tissue changes. The appliance opening should be cut approximately 3mm (1/8 inch) larger than the stoma diameter to prevent the appliance from rubbing or constricting the stoma while also protecting the peristomal skin from urine exposure. Too large an opening causes skin damage from urine; too small can traumatize the stoma.

8. What is the best time of day to collect a urostomy urine sample?

The best time is during a scheduled appliance change when the patient is comfortable and you can ensure proper technique. First morning samples may be more concentrated, but what matters most is the clean-catch technique. Coordinate with the patient’s usual appliance change schedule when possible to minimize unnecessary changes and skin trauma.

9. How much urine do I need to collect for urinalysis and culture?

For urinalysis, typically 10-20 mL is sufficient. For urine culture, most laboratories require at least 1-3 mL, though 5-10 mL is preferred. Check your facility’s laboratory requirements. It may take several minutes for enough fresh urine to drip from the stoma, so patience is important. Never squeeze or manipulate the stoma to force urine output.

10. What should I teach patients about caring for their urostomy at home?

Essential teaching includes: proper appliance changing technique, skin care and assessment, recognizing complications (infection, skin breakdown, stoma changes), when to seek medical attention, odor and gas management, pouch emptying and cleaning, ordering supplies, dietary considerations, and maintaining an active lifestyle. Patients should be connected with ostomy support groups and have follow-up with an ostomy nurse specialist.

📚 References

[1] Royal Marsden Hospital Manual of Clinical Nursing Procedures. Chapter 6: Elimination – Obtaining a Clean-Catch Urine Sample from an Ileal Conduit. Royal Marsden NHS Foundation Trust.

[2] Nursing and Midwifery Council (NMC). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Updated 2018. https://www.nmc.org.uk/standards/code/

[3] NHS England and NHS Improvement. Standard infection control precautions: national hand hygiene and personal protective equipment policy. 2019.

[4] Wound, Ostomy and Continence Nurses Society (WOCN). Basic Ostomy Skin Care: A Guide for Patients and Health Care Providers. Clinical Practice Guideline. 2018.

[5] United Ostomy Associations of America (UOAA). Living with a Urostomy Guide. 2020. https://www.ostomy.org/

[6] Burch J. Stoma Care. Oxford: Wiley-Blackwell; 2011.

[7] Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. St. Louis: Mosby; 2004.

[8] Department for Environment, Food and Rural Affairs (DEFRA). Guidance on the disposal of healthcare waste. UK Government. 2019.

[9] Kirkwood L. Essential Clinical Skills for Nurses: Step by Step. Oxford: Wiley-Blackwell; 2015.

[10] American Society of Clinical Oncology (ASCO). Urinary Diversion: What to Expect. Cancer.Net Patient Education. 2021.

[11] European Association of Urology Nurses (EAUN). Evidence-based Guidelines for Best Practice in Urological Health Care: Urinary Diversion. 2016.

[12] National Institute for Health and Care Excellence (NICE). Healthcare-associated infections: prevention and control. Quality Standard QS113. 2016.