This topic is about someone who has had a urostomy for five years and is dealing with frequent kidney and urinary tract infections. They have been using Trimethoprim, an antibiotic, but are concerned it might not be effective for people without a bladder. They are seeking advice on whether these infections are unavoidable and looking for practical tips or alternative solutions.

Here are some helpful suggestions:

1. Consult a urologist, preferably the one who performed the original surgery, instead of just a general practitioner. Request imaging studies to check for issues like reflux, kidney stones, or other structural problems.

2. Practice strict hygiene with your pouch:
- Always wash your hands thoroughly before changing your pouch.
- Change the entire pouching system every 3 to 4 days to prevent bacterial growth.
- Some doctors suggest adding a small amount of Betadine (povidone-iodine) to the pouch, but this is based on anecdotal evidence. Discuss this option with your urologist or stoma nurse first.

3. Manage your hydration:
- Stay well-hydrated, but avoid drinking excessive amounts of fluid that might dilute the antibiotic's effectiveness.
- Carry water with you and avoid staying in the heat or sun for too long to prevent dehydration.

4. Consider urine acidification measures to help prevent bacteria from sticking:
- Drink 1 to 2 glasses of cranberry juice daily or use cranberry tablets or capsules.
- High-dose vitamin C might help, but it can increase the risk of kidney stones, so only use it under the guidance of a urologist.

5. For accurate urine culture, collect specimens properly:
- Obtain urine via sterile catheterization of the stoma, or by removing the appliance, cleaning the stoma with a sterile technique, and catching urine directly into a sterile container. Do not collect urine from the pouch.

6. Long-term or preventive antibiotics, like daily Trimethoprim 100 mg, are sometimes prescribed for recurrent infections. Their effectiveness can vary, so it's important to have regular check-ups with a urologist.

7. Recurrent infections and stones might be caused by urine refluxing toward the kidneys. Identifying and treating reflux or stones can help reduce the frequency of infections.