A COMPACT SET OF SLIDES WITH COMPLETE MATTER

1. URINARY
DIVERSIONS
MINU REBECCA ISSAC
ASST.PROFESSOR, INE, SME,PTA

2. URINARY DIVERSION PROCEDURE IS PERFORMED TO
DIVERT URINE FROM THE BLADDER TO A NEW EXIT
SITE USUALLY THROUGH A SURGICALLY CREATED
STOMA IN THE SKIN.
INDICATIONS
1) PELVIC CARCINOMA
2) BIRTH DEFECTS
3) URETERAL STRICTURES
4) INTERSTITIAL CYSTITIS/ PAINFUL BLADDER SYNDROME
5) NEUROGENIC BLADDER
6) INCONTINENCE
7) TRAUMA TO THE URETERS/ URETHRA
8) CHRONIC INFECTION CAUSING URETERAL/ RENAL
DAMAGE

3. TYPES
A. INCONTINENT URINARY DIVERSION / CUTANEOUS
URINARY DIVERSION
DIVERSION TO THE SKIN, REQUIRING AN APPLIANCE
1. ILEAL CONDUIT
OLDEST AND MOST COMMON UD PROCEDURE.
 IT IS THE TRANSPLANTATION OF THE URETERS TO AN
ISOLATED SECTION OF THE TERMINAL ILEUM (ILEAL
CONDUIT)BRINGING ONE END TO THE ABDOMINAL
WALL.
 IT COULD ALSO BE TRANSPLANTED IN
COLON/PROXIMAL JEJUNUM
 THE RESECTED ENDS OF THE REMAINING INTESTINE
ARE ANASTAMOSED TO PROVIDE AN INTACT BOWEL
 URINE IS COLLECTED BY A COLOSTOMY OR AN
ILEOSTOMY BAG

5. 2. CUTANEOUS URETEROSTOMY
DETACHED URETER IS BROUGHT THROUGH THE ABD
WALL AND ATTACHES IT TO AN OPENING IN THE
SKIN
3. VESICOSTOMY
SUTURES THE BLADDER TO THE ABD WALL AND
CREATES A STOMA THRU THE ABDOMINAL AND
BLADDER WALLS FOR URINARY DIVERSION
4. NEPHROSTOMY
CATHETER IS INSERTED INTO THE RENAL PELVIS
THROUGH AN INCISION IN FLANK BY
PERCUTANEOUS CATHETER PLACEMENT IN THE
KIDNEY
5. URETEROSIGMOIDOSTOMY
ILEAL CONDUIT ANASTAMOSED TO SIGMOID COLON

7. B. CONTINENT URINARY DIVERSION
 IT IS AN INTRAABDOMINAL URINARY
RESERVOIRTHAT CAN BE CATHETERIZED OR
THAT HAS AN OUTLET CONTROLLED BY THE
ANAL SPHINCTER
 CONTINENT DIVERSIONS ARE INTERNAL
POUCHES CREATED SIMILAR TO ILEAL CONDUIT
 RESERVOIRS CAN BE FROM ILEUM, ILEOCECAL
LIGAMENT OR COLON

8. 1. INDIANA POUCH
 URETERS ARE INTRODUCED INTO A SEGMENT OF
ILEUM AND CECUM. URINE IS DRAINED BY
INSERTING A CATHETER INTO THE STOMA
2. CONTINENT ILEAL URINARY DIVERSIONS(KOCK
POUCH)
 URETERS ARE TRANSPLANTED TO AN ISOLATED
SEGMENT OF SMALL BOWEL AND DEVELOPS AN
EFFECTIVE CONTINENCE MECHANISM/ VALVE.
URINE IS DRAINED BY INSERTING A CATHETER
INTO THE STOMA
 IT IS USED IN FEMALES

10. 3. JUNCTURE OF POUCH AND URETHRA(MODIFIED
KOCK POUCH)
 IT IS USED IN MALES DUE TO SHORTENED
URETHRA IN FEMALES
 ATTACHING ONE END OF THE POUCH TO THE
URETHRA ALLOWING MORE NORMAL VOIDING
4. URETEROSIGMOIDOSTOMY
 THE URETERS ARE INTRODUCED INTO THE
SIGMOID COLON, ALLOWING URINE TO FLOW
THROUGH THE COLON AND OUT OF THE RECTUM

12. C. ORTHOTOPIC BLADDER RECONSTRUCTION
 IT IS ALSO CALLED ORTHOTOPIC NEO BLADDER,
WHERE A CONSTRUCTION OF NEW BLADDER
USING AN ISOLATED SEGMENT OF DISTAL ILEUM IN
THE ANATOMIC POSITION OF THE BLADDER WITH
DISCHARGE OF URINE THROUGH THE URETHRA.
 THE RESERVOIR CREATED IS A LOW PRESSURE
ONE.
 VARIOUS PROCEDURES INCLUDE THE HEMI-KOCK
POUCH,THE STUDER POUCH AND ‘W’ SHAPED
ILEONEOBLADDER

13. NURSING
MANAGEMENT

14. PRE-OPERATIVE
ASSESSMENT
 CARDIOPULMONARY FUNCTION TESTS
 NUTRITIONAL STATUS
 EMOTIONAL SUPPORT
MANAGEMENT
 RELIEVING ANXIETY
 ENSURING ADEQUATE NUTRITION
 A LOW RESIDUE DIET AND ADEQUATE HYDRATION TO
PREVENT HYPOVOLEMIA
POST-OPERATIVE
ASSESSMENT
 MONITOR CATHETERS AND DRAINAGE DEVICES
 URINE VOLUME, DRAINAGE PATENCY AND COLOUR OF THE
DRAINAGE
 REPORT SUDDEN DECREASE IN THE URINE VOLUME OR
INCREASE IN THE DRAINAGE
 PROPER MONITORING OF THE PAIN (VAS, NRS)

15. MANAGEMENT
 MAINTAINING SKIN INTEGRITY
 RELIEVING PAIN
 IMPROVING BODY IMAGE
 MONITORING AND MANAGING POTENTIAL
COMPLICATIONS
COMMON ARE
i. RESPIRATORY DISORDERS
ii. FLUID AND ELECTROLYTE IMBALANCES
iii. FECAL/ URINARY LEAKAGE
iv. PERITONITIS
v. STOMA ISCHEMIA AND NECROSIS
vi. STOMA RETRACTION AND SEPERATION

16. PROMOTING HOME CARE AND PATIENT EDUCATION
1) PINK OR RED AND MOIST LIKE THE INSIDE OF
THE MOUTH
2) INSENSITIVE TO PAIN BECAUSE IT HAS NO NERVE
ENDINGS
3) VASCULAR, WHICH MEANS IT MAY BLEED WHWN
CLEANED
4) IF GI TRACT IS USED TO CREATE UD, MUCUS MAY
BE VISIBLE IN URINE
CONTINUING CARE
 FOLLOW-UP
 VISIT
 MONITORING ANEMIA TO IDENTIFY VIT B 12
DEFICIENCY

17. POST OPERATIVE EVALUATION
a) MAINTAINS SKIN INTEGRITY
b) REPORTS RELIEF OF PAIN
c) IMPROVED BODY IMAGE
d) SELF AND FAMILY COPING
e) ABSENCE OF COPLICATIONS