Urinary diversion procedures divert urine from the bladder to a new exit site in the skin through surgery. Indications for urinary diversion include cancer or tumors of the bladder, pelvic malignancies, birth defects, and others. Complications can include alterations in bowel motility, leaks, fluid collections, fistulas, hernias, and more. Common types of urinary diversion are cutaneous (ileal conduit, cutaneous ureterostomy) and continent (continent ileal reservoir like the Indiana pouch, ureterosigmoidostomy). Nursing management focuses on monitoring output, preventing infections and complications, caring for the ostomy, patient education, and encouraging fluids.

1. URINARY
DIVERSION
Mr. ANILKUMAR BR. M.sc N.
LECTURER Medical-surgical
Nursing

2. Urinary
diversion....
...

3. Dedicated to
shree
Katildurga
pharameswa
ri

4. Introduction • Urinary diversion procedures
are preformed to divert urine
from the bladder to a new
exist site,usually through a
surgically created opening in
the skin.

5. Indications
of urinary
diversion
1. Cancer or tumour of the urinary
bladder, less frequently, a benign
condition
2. Management of pelvic malignancy
3. Birth defects
4. Strictures
5. Trauma to the ureters and urethra
6. Neurogenic bladder
7. Chronic inflammatory conditions
causing severe ureteral and renal
damage

6. Complicatio
ns of urinary
diversion
• Numerous surgical procedures
have been developed for urinary
diversion.
• All types of procedures have
variety of complications because
urinary diversion procedures are
complex, early and late post-
surgical complications frequently
occor.

7. Complicatio
ns of urinary
diversion...
Continues..
Possible complications including...
1. Alterations in bowel motility
2. Anastomotic leaks
3. Fluid collections ( abscess,
urinoma,lymphocele and heamotoma)
4. Fistulas
5. Peristomal herniation
6. Ureteral strictures
7. Renal calculi and tumor reoccurnce

8. Types of
urinary
diversion
1. CUTANEOUS URINARY
DIVERSION
A) ileal conduit (ileal loop)
B) Cutaneous ureterostomy
2. CONTINENT URINARY
DIVERSION
A) Continent ileal urinary diversion
( Formerly know as “ Indiana
pouch)
B) Ureterosigmoidostomy

9. Cutaneous
urinary
diversion
ileal conduit ( ileal loop)
• This method of urinary diversion is
the oldest and most common of
the UD because of the low number
of complications and surgeon’s
familiarity with the procedure.
• in an ileal conduit, the urine is
diverted by implanting, the ureters
into a 12-cm loop of ileum that is
led out through the abdominal
wall.

10. Continues.. • Stents, usually made of thin
,pliable tubing, are placed in the
ureters to prevent occlusion
secondary to post-surgical edema.
• The bilateral ureteral stents allow
urine to drain from the kidney to
the stona and provide a method
for accurate monitoring of urine
OPT

11. Continues.. • After surgical procedure, a skin
barrier and a transparent,
disposable urinary drainage bag
are applied around the conduit
and connected to drainage.
• The clear bag allows the stoma to
be inspected and the patency of
the stent and urine output to be
monitored.

12. Common
complications
• Wound infection or wound
dehiscence
• Urinary leakage
• Ureteral obstruction or blockage
• Hyperchloremic acidosis
• Small intestine obstruction
• Gangrene of the stoma
• Renal caluli and pyelonephritis
• Renal deterioration due to
chronic reflux

13. Nursing
management
• The nursing management
including in the post operative
period monitor urine out put ever
hour.
• Monitor closely for complications
• Practice hand hygiene and aspetic
technique during care of the
patient

14. Nursing
management
• Providing stoma and skin care
• Testing urine and caring for the
ostomy
• Encouraging fluids an reliving
anxiety
• Prevention of infection and
complications
• Patient teaching

15. Cutaneous
ureterostomy
• A cutaneous ureterostomy in
which the ureters are directed
through the abdominal wall and
attached to an opening in the skin,
is used for selected patients with
ureteral obstruction.
• Because it requires less extensive
surgery than other types of
urinary diversion.

16. Continent
urinary
Diversions
• Continent ileal urinary
reservoir ( Indiana pouch)
The most common CUD is the
Indiana pouch, created for the
patient who’s bladder is removed or
no longer functions.

17. Continues • The Indiana pouch uses a
segment if the ileum and
cecum to from the reservoir
for urine.