Surgical Revision of Skin-Covered Urostomy Opening

Immediate Assessment and Planning

• The American Society of Colon and Rectal Surgeons recommends assessing for complete stomal retraction, stomal stenosis, or partial coverage to determine the need for urgent versus semi-urgent intervention in patients with skin-covered urostomy openings 1, 2

Surgical Approach

• The European Association of Urology suggests that the definitive treatment for skin-covered urostomy openings is surgical revision through local stomal revision or formal stomal relocation, which involves excising the overlying skin and re-maturing the stoma to restore proper urinary drainage 1, 2
• The American Urological Association recommends mobilizing the bowel segment to bring it back to skin level and re-maturing the stoma by suturing the mucosal edge to the skin with interrupted absorbable sutures, ensuring adequate protrusion 1, 2
• Placing the stoma through the rectus muscle is recommended to minimize future complications, as suggested by the Clinical Gastroenterology and Hepatology society 1, 3

Critical Technical Considerations

• The World Journal of Emergency Surgery suggests that ensuring adequate stomal protrusion of at least 1-2 cm above the skin surface and creating an appropriate stomal diameter are key surgical principles to prevent recurrence 1, 3
• Positioning the stoma through the rectus muscle provides fascial support and reduces the risk of retraction and hernia, as recommended by the Clinical Gastroenterology and Hepatology society 1, 3

Perioperative Management

• The American Society of Colon and Rectal Surgeons recommends consulting wound ostomy continence (WOC) nursing for preoperative stoma site marking if relocation is planned, and assessing for concurrent complications requiring simultaneous repair 1, 2
• Ensuring ureteral stents are functioning if present in the ileal conduit is crucial, as suggested by the World Journal of Emergency Surgery 4, 5

Common Pitfalls to Avoid

• The Clinical Gastroenterology and Hepatology society advises against attempting conservative management with catheterization or dilation alone when skin completely covers the opening, as this will fail and delay definitive treatment 2, 3
• Avoiding inadequate mobilization of the bowel segment and avoiding placing the stoma outside the rectus muscle during revision are also recommended to prevent complications 1, 2, 3