Pediatric stoma rehabilitation does not end with the establishment of toilet management for self-care. Physical and mental assistance,and counceling at each of development is also very important. It is necessary to provide long term medical,educational and social support to the patients as well as their families.

View full abstract

Fifteen patients with parmanent or a lomg-term stoma from childhood are discussed in relation to problems during adolescence and young-adulthood. These patients were survivors of cloacal extrophy,ischiopagus,rhabdomyosarcoma,intestinal Behçet's disease and intestinal dysmotility. The oldest patient was 30 years old. There were 13 intestinal stomas and 12 urinary tract stomas. Ten cases had double stomas. All of the patients had demonstrated various physical problems during adolescence such as the interventional treatment for stomas,associated anomalies and complications due to treatment of the underlying disease. Management and care for sexual dysfunction and sex hormone replacement were not satisfactory. These patients also had latent psychological problems including school problems. Although they have many handicaps. almost all of the patients have obtained steady jobs and are socially active. The problem of who should take total care of these complicated patients and which institute can offer the most appropriate care remains. One possible answer is to develop an institute for pediatric and “adult-pediatric” medicine. An other is a relational approach,pediatric surgical team and adult ostomy care team,would allow the individual patient to choose the most adequate care.

View full abstract

We conducted clinical reviews of three pediatric ostomates to in vestigate maturation problems on long-term follow-up from the perspective of stoma care in pediatric institutes.
One of the problems was that a good stoma site for a pediatric ostomate may become unsuitable with growth. A second problem was sexual issues in patients with ambiguous genitalia. Carefully planned reconstruction of the vagina and perineum should be adequately perfomed during adolescence in order to achieve an appropriate body image.An adequate plan for supplementation of sex hormones was also essential. A third problem was the methodology for obtaining cooperation and collaboration between pediatric and adult institutes.

View full abstract

Adolescent ostomates face various mental problems and uncertainty as a result of interactions with the environment. They hate their own body and are disfressed by that. In dealing with adolescent ostomates,it is important to 1)establish a mental bond with them,2)understand the important meaning of their words,3)recognize that they grow through experience,4)respect their independence and autonomy,and 6)understand that they are undergoing sexual development. It is important for care providers to be honest with them and try to understand their state of mind. It is necessary to offer a support system that makes it possible for adolescent ostomates to adapt themselves to changing environment and establish their own identity as they grow.

View full abstract

　We can list several problems concerning ostomates who have undergone the formation of a stoma in early childhood. These include:(1)their lack of information about the disease requiring the stoma and the type of surgery;(2)lack of familiarity with the diseases and operations by surgeons who typically treat only adults;(3)closure of the hospital where the patient underwent surgery and unavailability of medical records for further inquiry;(4)their partner being a barrier to communication;(5)no information on whether their physical problems were congenital or acquired by surgery;(6)their childish manner;(7)the intensity with which they apply themselves to their style of self-stoma care that impedes them from accepting a new method of stoma-care. In order to resolve these problems;(1)pediatric surgeons should offer full,objective information about their diseases and complications, and also prepare a copy (floppy disk, CD or MO) containing the ostomate's full medical records;(2)surgeons mainly treating adult diseases should continue to learn extraprofessional fields;(3)and all staff members in the pediatric wards should endeavor not to “coddle” or over-protect infantile ostomates at earlier ages.

View full abstract

　A questionnaire was performed to ostomates(600)in Hokkaido asking what they had sought consultation for and who had consulted them. Of the ostomates 41.2％(245)responded. 90.6％(222)of 245 had sought consultations,which were frequently about the instrument,bathing and skin. They had vsited most often a doctor or nurse for consultations of stoma rehabilitation, and also wished to choose a doctor and nurse for specializing management in stoma. This was clear that the ostomates seek for professional helping on stoma information and experience.

View full abstract