NCP Urinary Diversions / Urostomy (Postoperative Care)

Incontinent urinary diversions: These ostomies require permanent stoma care and external collecting devices.
Ileal conduit: Ureters are anastomosed to a segment of ileum, resected with the blood supply intact (usually 15–20 cm long). The proximal section is closed, and the distal end brought to skin opening to form a stoma (a passageway, not a storage reservoir).
Colonic conduit: This is a similar procedure using a segment of colon.
Ureterostomy: The ureter(s) is brought directly through the abdominal wall to form its own stoma.
Continent urinary diversions: Continent urinary reservoirs (CURs) have become one of the major options for patients to improve their quality of life regarding stoma care and the ability to sleep and travel.
Kock reservoir or Indiana (ileocecal) pouch: A section of intestine is used to form a pouch inside the patient’s abdomen, creating a reservoir that the patient periodically drains by inserting a catheter through the stoma, thus negating the need for an external collecting device.

CARE SETTING

Inpatient acute surgical unit.

RELATED CONCERNS

Cancer
Peritonitis
Psychosocial aspects of care
Surgical intervention
Patient Assessment Database
Data depend on underlying problem, duration, and severity, e.g., malignant bladder tumor, congenital malformations, trauma, chronic infections, or intractable incontinence due to injury/disease of other body systems (e.g., multiple sclerosis). (Refer to appropriate CP.)

TEACHING/LEARNING

Discharge plan

DRG projected mean length of inpatient stay: 5.5 days

May require assistance with management of ostomy and acquisition of supplies.

Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

Intravenous pyelogram (IVP): Visualizes size/location of kidneys and ureters and rules out presence of tumors elsewhere in urinary tract.
Cystoscopy with biopsy: Determines tumor location/stage of malignancy. Ultraviolet cystoscopy outlines bladder lesion.
Bone scan: Determines presence of metastatic disease.
Bilateral pedal lymphangiogram: Determines involvement of pelvic nodes, where bladder tumor easily seeds because of close proximity.
CT scan: Defines size of tumor mass, degree of pelvic spread.
Urine cystoscopy: Detects tumor cells in urine (for determining presence and type of tumor).
Endoscopy: Evaluates intestines for use as conduit.
Conduitogram: Assesses length and emptying ability of the conduit and presence of stricture, obstruction, reflux, angulation, calculi, or tumor (may complicate or contraindicate use as a urinary diversion).

NURSING PRIORITIES

1. Prevent complications.
2. Assist patient/SO in physical and psychosocial adjustment.
3. Support independence in self-care.
4. Provide information about procedure/prognosis, treatment needs, potential complications, and resources.

DISCHARGE GOALS

1. Complications prevented/minimized.
2. Adjusting to perceived/actual changes.
3. Self-care needs met by self/with assistance as necessary.
4. Procedure/prognosis, therapeutic regimen, potential complications understood and sources of support identified.
5. Plan in place to meet needs after discharge.