Urinary Elimination: Urinary Diversion

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URINARY DIVERSION

Meaning
It is the surgical rerouting of urine from kidneys to a site other than bladder.
Types/ categorics
There are two categories of urinary diversion
1.     Incontinent
2.     Continent
Incontinent
          With incontinent diversions the client has no control over the passage of urine and require the use of external ostomy appliance to contain urine. It may or may not involve cystectomy
v Ureterostomy:
  In this one or both of the ureters are brought directly to the side of abdomen to form small stomas. Each ureter forms unique stomas.



Disadvantages
Stomas provide direct access for microorganisms from skin to kidneys  Difficult to fit with an appliance to collect urine
v Nephrostomy
Nephrostomy is used to divert urine from kidneys to stoma.



v Vesicostomy
          It is formed when the bladder is left intact & voiding through urethra is not possible. Ureters remain connected to the bladder. The bladder wall is sürgically attached to an opening in the skin below navel



Ileal conduit/ ileal loop
In this procedure a segment of ileum is removed & the intestinal ends re attached. One end of the removed portion is closed with sutures to create a pouch & the other end is brought out through the abdominal wall to create a stoma. The ureters are implanted into the ileal pouch. Urine drains out continuously.


Continent
With continent urinary diversion a continence mechanism is created giving client control over the passage of urine either by intermittent catheterization of the internal reservoir (kock pouch) or by strained voiding (neobladder)
v Kock pouch/continent ileal bladder:
It uses a portion of the ileum to form a reservoir for urine. Nipple valves are formed by doubling the tissue backward into the reservoir where the pouch connects to the skin & the ureters connect to the pouch.
The valves close as the pouch fills with urine preventing leakage & reflux. It is emptied every 4 hours, by inserting a clean catheter. Small dressings are worn to protect the stoma & clothing.



v Bladder reconstruction (neobladder)
Replaces a diseased or damaged bladder with a piece of ileum, thus making a new bladder.
The surgeon forms the piece of bowel (ileum) into a new bladder and sews this to the Ureters. It is attached to urethra. So after the operation, urine flows down the Ureters as normal, and collects in the pouch forming the new bladder.

Nurses' role
v Assess intake and output accurately.
v Observe urine, stoma & surrounding skin condition. 
ü Stoma looked for color
ü Skin inspected for irritation
ü Bleeding wound infections
·        Recognizing Infection
·        dark urine or urine containing excess mucus
·        strong-smelling urine
·        pain in the back
·        poor appetite
·        nausea        
·        vomiting
v Ensure well-fitting urine collection appliances.
v Change of appliances
v Assist with coping & counseling
Explain the procedures associated with stoma care, wound care & Changing pouch. Clear the concerns of the patient regarding the diversions.

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notes.nursium.com: Urinary Elimination: Urinary Diversion
Urinary Elimination: Urinary Diversion
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