Urinary Diversion Case Study

It is a surgical procedure that changes the normal flow of urine from the bladder to a new exit site out of the body when urine flow is blocked.

Indications:

Urinary diversion is performed in case of:

• Bladder tumor that indicate cystectomy.

• Genitourinary tumors

• Neurogenic bladder.

• Birth defects of the urinary tract.

• Strictures.

• Trauma to the ureters or urethra.

• Chronic infection causing renal damage.

• Incontinence.

Types of Urinary Diversion: o Cutaneous Urinary Diversion:

It involves connecting the ureters to a part of the intestine that drains out in the abdominal wall. The urine is drained out to a stoma bag that is placed under the clothes.

o Continent Urinary Diversion:

It involves making a pouch (reservoir) inside the

Pre-operative Care: o Take a complete health history including any recurrent infections. o Head to toe assessment including cardiovascular, respiratory, and gastrointestinal. o Smoking cessation if the patient smokes. o Blood tests including Blood type and cross matching. o Chest X-ray. o Electrocardiogram. o Dental evaluation. o Contact the stoma care nurse specialist (SCNS) prior to surgery to allow for counseling to take place. o Ask the patient to take a shower using soap and water the evening before surgery. o Instruct the patient to stay NPO for at least 8 hours. o Explaining the procedure to patient and taking an informed consent signed by the patient. o Hair around the incision site should be removed on the day of surgery using electric clippers. o Allergies should be documented. o Dentures and jewelries should be removed. o Surgical site preparation. o Insertion of IV or saline lock as indicated. o Administration of any prescribed medications.

Post-operative Care: o Assess the patient's airway, vital signs and level of consciousness. o Assess surgical site (intact dressings with no signs of bleeding). o Assess the IVF for rate and

o Patients should rinse and clean the pouch daily and change it every 5 to 7 days. o When changing a pouch, patients need to clean the skin around the stoma with a wet towel. o The skin should be completely dry before applying a new pouch. o If the constant flow of urine from the stoma irritates the skin, patients can use protective skin wipes or an ostomy powder designed to protect the skin around the stoma.

• Caring for a Continent Cutaneous Reservoir: o Patients can drain the reservoir by inserting the catheter while standing in front of the toilet or sitting on the toilet. o During the first few weeks after urinary diversion surgery, patients need to drain the internal reservoir every tow of hours. o Over time, the reservoir capacity will increase and patients will be able to go 4 to 6 hours between reservoir