This topic is about someone who has had a urostomy for 40 years and is now dealing with severe skin irritation around the stoma. The irritation is painful, looks like a wet callus, and burns intensely. Despite trying several remedies, the problem persists. The person is using the ConvaTec Natura Flexible series and is seeking advice for relief.

Here are some helpful suggestions:

1. **Seek Professional Help**: It's important to see an ostomy nurse or doctor to check for infections or other complications. Antibiotics might be needed if there's an underlying infection.

2. **Perfect the Wafer Opening**:
- Cut the wafer so the hole matches the stoma size closely. Even small gaps can cause urine to irritate the skin.
- Use a firm template for accurate cutting.
- Consider switching to a two-piece system for better visibility and fit.
- Change the flanges as soon as they show signs of wear, which might mean daily changes until the skin heals.

3. **Control Urine pH and Contact Time**:
- Use vinegar soaks by placing a vinegar-soaked gauze over the stoma for 8–10 minutes during changes.
- Add a small amount of vinegar to the pouch each time you empty it to neutralize urine.
- Take vitamin C to lower urine pH and prevent crystal formation.
- Drink more fluids to dilute the urine.

4. **Keep the Surface Dry and Protected**:
- Avoid using creams or a hair-dryer on the irritated area as they can worsen the condition.
- Lightly dust the skin with Stomahesive or Karaya Powder before applying the wafer.

5. **Address Fungal or Bacterial Complications**:
- If there's itching or redness, use Mitrazol powder and let it dry before reapplying the appliance.
- Severe cases might need prescription treatments like Beta-Val under medical supervision.

6. **Product and Feature Notes**:
- Consider using products like ConvaTec Natura Flexible flanges, Stomahesive Powder, and wafers with non-reflux valves.
- Mitrazol antifungal powder and Beta-Val cream can be helpful.
- Two-piece pouches from various brands might offer better fit and comfort.

7. **Monitor Medications**: Some medications can make urine more irritating. Consult your doctor if you suspect this might be the case.

8. **General Routine Tips**:
- Rinse and dry the pouch thoroughly during changes.
- Schedule changes during times of low output, like before bed.
- Keep supplies ready for quick changes to minimize skin contact with urine.