Continent Urinary Diversion (CUD) Flashcards
Mitrofanoff Procedure (low pressure/high volume) - neurogenic bladder (use bladder as reservoir & augment) if bladder removed: use bowel segment w/ muscle fibers interrupted Bladder augmented w/ appendix (anastomosed to umbilicus) eg. appendicovesicostomy
1
Q
3 critical components for any CUD
A
- Low pressure, high volume reservoir
- Antireflux mechanism
- Continence mechanism (narrow channel between reservoir & abd wall)
2
Q
Contraindication for CUD
A
- Motivated to catheterize (lifetime)
- Previous Radiation
- Renal failure pt = metabolic complications
3
Q
Antireflux mechanism & continence mechanism (how constructed) for Koch Urostomy & Indiana Reservoir
A
One way value (intussusception - nipple valve @ proximal end (no urine reflux)
less chance of pouchitis r/t lower bacteria growth from urine
4
Q
Longterm catheterization frequency for pt w/ CUD
A
- q1-2 hours, then increase 1 hours weekly
- q4h + once during hs + prn
Prevent overdistention of reservoir
Prevent pouchitis & UTI
Prevent incontinence
5
Q
Guidelines for teaching pt how to intubate
A
Routine Intubation #14-16 Fr catheter Wash hands & catheter, lubricate insert 3-4 inches rotate catheter prn Drain reservoir, remove catheter Wash catheter w/ soapy warm H20, rinse/dry Store in Baggie Prn soak in 1/2 strength white vinegar (odor) replace catheter if cracked/stiff
6
Q
Impact of Koch Urostomy on B12 absorption
A
75 cm of small bowel, requires Vit B12 replacement for life
7
Q
S/S anastomotic breakdown & appropriate response
A
extravasation of urine
increased drainage from penrose
decreased drainage from reservoir catheter/stents
