This topic is about managing persistent leakage issues for a paraplegic man who uses a wheelchair and has a urostomy. The stoma is flush with the skin and located low on the abdomen, which causes challenges, especially when seated. Recent weight gain has also changed the abdominal shape, making it difficult to maintain a good seal with the ostomy appliance. Here are some suggestions to help manage these issues:

1. Consider using a soft convex pouching system. These systems can help a flush stoma protrude slightly, improving urine flow and allowing the barrier to fit more snugly against uneven skin. You can contact your preferred supplier to request free samples and see which one works best.

2. When applying the appliance, make sure to:
- Clean the skin around the stoma thoroughly with ostomy wipes before each change.
- After placing the flange or wafer, gently warm it with a hair dryer and then press your hand over the appliance for about five minutes. This can help improve adhesion and create a tighter seal.

3. To manage continuous drainage while seated, you can attach extension tubing from the pouch outlet to a plastic bottle mounted on the wheelchair or bedside. This setup keeps the pouch empty, reduces backpressure, and minimizes the risk of the barrier lifting off due to over-filling.

4. Adopt a proactive change schedule, such as changing the appliance every seven days, even if it could last longer. Planning changes before the appliance wears out can help prevent unexpected leaks.

5. While specific brands like Hollister are mentioned, any manufacturer that supplies soft convex barriers and extension tubing can be considered.