Objective To explore the predicament during the course of discharge preparation in older patients with urostomy, and to provide reference for nursing process of discharge.Methods A purposive sample of 16 patients who underwent radical cystectomy with urinary diversion for bladder cancer participated in this study.Semi-structured interviews were conducted and the Colaizzi′s seven-step method of phenomenological analysis was used to extract themes.Results Two themes and nine sub-themes emerged: the self-perceived experiential predicament (discharge decision-making, symptom management, ostomy self-care skills, daily life, negative moods, and role adaptation) and the support system predicament (family support, medical support, and social support).Conclusion Older patients with urostomy face various predicaments in the course of discharge preparation.Healthcare professionals should conduct comprehensive assessments and implement targeted interventions to reduce these predicaments, enabling patients to smoothly return to their families and society.