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.
COMMENTS