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Urinary Diversions:
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1851- Ureteroproctostomy (Simon)
1878- Ureterosigmoidostomy (Smith)
1950s- Ileal loop (Bricker)
1959- Ileal neobladder (Camay)
1970s to early 80s- Koch and Indiana
Late 80s- Orthotopic diversion
History of Diversion Surgery
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What Necessitates Urinary
Diversions?
Invasive bladder cancer
Hostile neurogenic bladder
Interstitial or radiation cystitis
Congenital abnormalities
Intractable incontinence
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6th most common cancer in U.S.
New cases: 73,510
Deaths: 14,880
3x more common in men
Bladder Cancer Facts
National Cancer Institute, 2012
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Urostomy (ileal conduit)
Continent Cutaneous Urostomy
Orthotopic Neobladder
Urinary Diversion Options
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Non-continent
Ureterostomy
Ileal Conduit
Continent
Indiana Pouch (continent cutaneous)
Orthotopic Neobladder
Non-continent vs. Continent
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Surgical Selection Factors
Availability of surgeon and O.R.
Age of patient
Comorbidities
Renal function
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Location of tumor
Sphincter competence
Hx of pelvic radiation
Hx of bowel disease
Surgical Selection Factors
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Manual dexterity
Mental status
Weight
Patient preference
Surgical Selection Factors
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Duke: 60% ileal conduits, 40% internal
continent pouches (2012)
Prevalence of Continent
Diversions
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Ileal pouch in native anatomical
location
AKA
Studer diversion
Orthotopic Neobladder
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Cons
Delayed continence
Urinary retention
Metabolic acidosis
Catheterize
Pros
Cosmesis
No stoma
Independentlyvoid
Cost effective
Orthotopic Neobladder
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Orthotopic Neobladder Pouchogram
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Symptoms: Prevention:
Fever Irrigation
Bacteriuria Fluid intakePouch pain
Treatment:
Antibiotics (Flagyl)
Pouchitis
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Voiding
Q2hr day and Q3hr at night
Ultimately Q 4hr day & Q 8hr night
Valsalva, Cred method, sit on toilet
Measure and record output
Activation Teaching: NB
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Crede Maneuver
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Kaufman DS, Shipley WU, & Feldman AS. Bladder Cancer.Lancet. 2009;374(9685):239-247.
Hautmann RE, Abol-Enein H, Hafez K, et al. Urinary diversion.
Urology. 2007; 69(suppl):1749, 2007.
Somani BK, Gimlin D, Fayers P, et.al. Quality of life and bodyimage for bladder cancer patients undergoing radical
cystectomy and urinary diversion. Urology. 2009; 74(5):1138-43.
Nabil G, Cody JD, Dublin N, et.al. Urinary diversion and bladder
reconstruction/replacement using intestinal segments for
intractable incontinence or following cystectomy. 2009 TheCochrane Collaboration/JohnWiley & Sons, Ltd.
References
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Gray M & Beitz JM. Counseling patients undergoing urinarydiversion: does the type of diversion influence quality of life?
JWOCN.2005. Jan-Feb;32(1):7-15.
Gemmill R et al. Going with the flow: quality of life outcomes of
cancer survivors with urinary diversion. JWOCN 2010. Jan-
Feb;37(1):65-72.
Dutta SC et al. HRQOL assessment after radical cystectomy:
comparison of IC and ON. J Urol 2002;168(1):164-167
Gerharz EW et al. QOL in patients with bladder cancer. Urol
Oncol 2005;23(3):201-207.
References
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Kikuchi E et al. Assessment of Long-Term Quality of Life Usingthe FACT-BL Questionnaire in Patients with an IC, CR, or ON.
JJCO2006; 36(11)712716
References
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http://www.uoaa.org/ostomy_info/
http://www.uoaa.org/ostomy_info/
http://bcan.org
http://www.wocn.org
http://www.ostomysecrets.com
http://www.options-ostomy.com
http://www.trianglebcs.org
Patient Resources
http://www.uoaa.org/ostomy_info/http://www.uoaa.org/ostomy_info/http://bcan.org/http://www.wocn.org/http://www.ostomysecrets.com/http://www.options-ostomy.com/http://www.options-ostomy.com/http://www.options-ostomy.com/http://www.options-ostomy.com/http://www.ostomysecrets.com/http://www.wocn.org/http://bcan.org/http://www.uoaa.org/ostomy_info/http://www.uoaa.org/ostomy_info/Top Related