urinary diversions Flashcards
sigmoid colon
ileum
sigmoid colon- large intestine
ileum - small intestine
types of urinary diversion devices
- ileal conduit
- continent cutaneous reservoir
- orthotopic neobladder
ileal conduit
*incontinent to skin
*anatomized ureters to ileum and route ileum to surface of skin, urine constantly coming out –> urine goes from ureters to stoma (visible) and collects in the permanent external bag (forever)
*ileum secretes mucus on an ongoing basis, so urine will likely have mucus in it –> EXPECTED FINDING
*body image and skin integrity concerns
which is the gold standard urinary reconstruction diversion? why?
ileal conduit
procedure of choice if significant comorbidities or shorter life expectancy
cutaneous diversions
continent
-indiana, kock, Miami pouches
-intermittent, life-long clean, self-catheterization
-NO external bag
-stoma on abd wall
*largely replaced by orthotopic neobladder
orthotopic neobladders
continent
-internal reservoir connected to urethra
^constructed from a segment of intestine (ileum) that’s separated from bowel and anastomosed to the urethra
which urinary diversion most closely approximates normal voiding, thus is a procedure of choice after cystectomy?
orthotopic neobladder
pre-op cystectomy management
address anxiety and fear & teaching needs (post op care)
include WOCN
post-op management
NPO and NG to LWS for a few days
patient teaching: ileal conduit
ensure properly fitting appliance
provide meticulous skin care
mucous in urine = expected
stomal assessment = beefy red, moist
post-op patient teaching: continent diversion
cath every few hours at first
extend to q 4-6hr over time
post-op patient teaching: neobladder
void by relaxing sphincter and bearing down
**will not feel the urge to void, so go every 2-4 hours –> takes practice to know how to void normally
practice pelvic floor muscle relaxation to help pee
