Approximately three weeks from your date of surgery you will return to the office for a check-up. This might include an X-ray of your new bladder (pouch) and/or a blood draw. If you have no complications, you will return within a few days to have the catheter removed from your stoma. We will teach you how to empty your pouch and how to measure your urine output. You will return two or three days later. If you are not having any problems, the second tube will be removed. We will have you return approximately two weeks later for blood tests and a renogram (measures kidney function). Three months later we will have you return for more blood tests, another renogram and an exam.

Instructions for catheterizing your pouch

EQUIPMENT

• 16 or 18 French red rubber catheter (straight or coude)
• Water-soluble lubricant
• Wash cloth or towelette without alcohol
• Clean towel or paper towel
• Ziploc plastic bags
• Paper tape
• Catheter tip irrigating syringe (60 cc)
• Skin sealant wipe

1. Wash hands with soap and water.
2. Assemble equipment.
3. Stand or sit over toilet or sink.
4. Wipe stoma with water or towelette (without alcohol).
5. Lubricate catheter tip with WATER-SOLUBLE lubricant. DO NOT USE A PETROLEUM-BASED LUBRICANT.
6. Gently insert catheter into stoma. Some resistance can be felt at the valve.
7. Allow urine to drain.
8. If urine does not begin to drain, the catheter may be in a "pocket" of the pouch. There are several things you can try:
• Rotating the catheter
• Moving the catheter in or out slightly
• Changing your position (bend at the waist, lie on your side)
• Irrigating your pouch
9. To irrigate the pouch, fill a syringe with saline and connect it to the catheter. Slowly push syringe to instill the fluid. When the syringe is empty, pull back gently to draw the fluid back. If the syringe will not pull back, you can add another 30-40 cc of saline and try again. If it still will not pull back, disconnect the syringe from the catheter and allow the fluid to drain.
10. Be sure to drain the entire amount of fluid instilled in addition to the urine. Once the flow of urine stops, slowly remove the catheter, allowing urine to drain as the catheter is removed.
11. Remove the catheter.
12. Hand wash the catheter with soap and water after catheterizing. Rinse the catheter well with warm water. If the catheter cannot be washed immediately, store it in a Ziploc bag and wash as soon as possible.
13. Apply covering to stoma. (Place a panty liner on the inside of briefs or use tape gauze over stoma.)
14. A skin sealant wipe can be periodically applied to the skin around the stoma to protect the skin from tape irritation.

CATHETER CARE

1. Hand wash the catheter with warm soapy water.
2. Squirt soap into catheter and run water through.
3. Rinse catheter WELL with warm water.
4. Hang dry over a clean towel or towel rack.
5. When completely dry, store catheter in a plastic bag.
6. Make it a habit to throw away old catheters and open new ones at the beginning of every month. Discard any catheters that become discolored or cracked before one month.

POUCH EMPTYING SCHEDULE
The pouch should be emptied at regular intervals and whenever there is a sensation of fullness. It's important to monitor the amount of urine in the pouch so it does not exceed 500 cc.

FIRST WEEK
For several days after your stomal catheter is removed, you will measure the amount of urine that drains from the catheter AND from the suprapubic tube. You will record these amounts on a voiding log which you must bring with you to your next appointment. Remember to catheterize your stoma FIRST and record the amount and THEN drain the urine from the suprapubic tube and record that amount. Catheterize every three hours while awake and every four hours at night. Irrigate two or three times per day or more frequently if you have a lot of mucous.

SECOND WEEK
Catheterize every three to four hours while awake and once at night. Irrigate twice daily (more frequently if necessary).

THIRD WEEK
Catheterize every four hours while awake. If output is more than 500 cc, you will need to catheterize more frequently and be more aware of your fluid intake. Irrigate once daily (more frequently if necessary).

FOURTH WEEK
Catheterize every four hours while awake. Irrigate two or three times per week (more frequently if you still have a lot of mucous.)

POINTS TO REMEMBER

• For your safety, you may want to wear to medical alert bracelet or carry an identification card. The bracelet or card should indicate "CONTINENT UROSTOMY -- MUST INSERT CATHETER TO DRAIN."
• Have catheterization and irrigation equipment with you at all times. A small tote or cosmetic bag makes a convenient carrying case. Keep extra equipment at work, school and in the car. When traveling, pack catheterization equipment in carry-on luggage. Clothespins can be used to hold clothing away from the stoma during catheterization.
• Empty your pouch on a schedule and any time you feel full. Do not skip a catheterization.
• Daily fluid intake: two quarts of liquid (eight 8 ounce glasses of fluid).
• Notify us if you have:
• Temperature over 100 degrees Fahrenheit
• Chills
• Foul-smelling or concentrated urine
• Blood in urine
• Back or abdominal pain
• To reduce the risk of infection, be sure to empty the pouch completely with each catheterization. When the flow of urine stops, slowly remove the catheter, allowing any additional urine to drain from the bottom of the pouch.
• After your physician has given his approval, you may resume your regular activities. Tub baths, showers and swimming are not restricted.
• Part of your intestine was removed to make your pouch. Some people will experience diarrhea for several months as the intestine slowly adjusts to the change. If you experience diarrhea, call the clinic and talk with the nurse. Once it has been determined that you do not have an infection, anti-diarrheal medications, such as Lomotil, may be prescribed. Nevertheless, altering your diet and adding a bulk-forming fiber medication, such as Metamucil, may be all that is needed. Eating smaller, more frequent meals may help. Keep a record of everything you eat to see if one particular food is the cause.
• Avoid spicy or gas-producing foods for several months after surgery. These can cause spasms in your new pouch.
• Try to maintain your ideal weight after surgery. A large weight gain can cause the pouch and valve to change position and make catheterization difficult.
• Catheters and irrigating syringes can be obtained at a medical supply store. A prescription is required for irrigating saline. Call your pharmacy in advance because not all pharmacies carry it in stock.