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As the main undertakers of home care for urostomy patients after discharge, family caregivers play an important role in patients' postoperative recovery. Family caregivers of patients with urostomy may be under greater pressure than patients themselves, and there is a heavy burden on caregivers, and their care needs are complicated and urgent. However, there is a lack of research on the care needs of family caregivers of bladder cancer patients with urostomy, and tools to assess the specific needs of family caregivers of bladder cancer patients with urostomy are lacking. This study aimed to develop an assessment tool to measure the specific needs of family caregivers for bladder cancer patients with urinary ostomies and to examine its reliability and validity. The development of the scale is based on the Supportive Care Framework, and the item pool is determined through literature retrieval and qualitative research. The items of the scale were revised via Delphi expert consultation, and 198 family caregivers of urostomy patients in five 3 A hospitals in Taiyuan City, China, were investigated. SPSS 26.0 and AMOS 22.0 were used for data analysis. Exploratory factor analysis and confirmatory factor analysis were carried out to evaluate the reliability, content validity, discrimination validity, structure validity, and convergence validity of the scale. Exploratory factor analysis identified three dimensions of the 21-item scale of care needs of family caregivers of patients with bladder cancer undergoing urostomy, namely, demand for disease information, demand for physical and mental comfort, and demand for social support. Cronbach's α coefficient and half-reliability of the whole scale and each dimension are greater than 0.7, indicating high internal consistency. Confirmatory factor analysis shows that the scale fits the data well, and the content validity, discrimination validity, and convergence validity of the scale are excellent, which provides evidence of support. The scale developed by the authors is a relatively reliable and effective tool for evaluating the specific care needs of family caregivers of patients with bladder cancer undergoing urostomy. Future research could develop role-specific subscales tailored to distinct kinship categories (e.g., spouses, daughters, sons) to enable precision assessment of caregiving needs.