Term
| what is urinary diversion |
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Definition
| diverting urine out of the body using ana lternative pathway --> can be either continent or incontinent |
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Term
| patients with an incontinent diversion must always? ... |
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Definition
| wear a pouch to collect urine |
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Term
| how is the bowel used in incontinent diversion? |
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Definition
| the bowel is used to create a stoma and ureters are implanted in the bowel. smaller lengths are required for incontinent diversion than are for continent diversion and less surgical time is involved |
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Term
| How is bowel used in continent urinary diversion? |
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Definition
| in continent diversion, the bowel is used to create a reservoir that can store urine. Ureters are attached to the reservoir and a catherizable stoma is created |
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Term
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Definition
| a common type of incontinent diversion created by removing a portion of the last segment of the ileum and reconnecting the rest of the small intestine so that everything continues function |
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Term
| why does the surgeon try to preserve the last 12-15 cm of the ileum? |
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Definition
| because that area is closest to the ileocecal valve and is important in the absorption of vitamin b12 and bile |
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Term
why must patients having a continent diversion have good renal function and healthy bowel?
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Definition
| because more of the bowel is required to create a continent urinary pouch |
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Term
| the distal end of the resected ileum is... |
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Definition
| used to create a stoma in the abdominal wall usually in rlq |
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Term
| what are the ureters attached to in incontinent diversion |
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Definition
| the other end of the ileum where the urine then travels through the conduit and exits the stoma in an external collection pouch |
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Term
| why are ureteral stents placed? |
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Definition
to help maintain patency of the ureters and bowel
they are usually left in place 5-7 days with incontinent diverison; and 5-10 post op with continent diversion |
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Term
| what lab values need to be monitored |
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Definition
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Term
| most common complications after incontinent diversion |
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Definition
stomal stenosis
prolapse
parastoma hernia
stomal retraction |
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Term
| patients are at risk for ______? with both diversions |
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Definition
| hyperchloremic metabolic acidosis with hypokalemia caused by prolonged contact of the urine with intestinal mucosa |
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Term
| why are they at risk for this? |
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Definition
| the intestinal mucosa is very absorptive which means that normally excreted sodium and chlorine in the urine are reabsorbed by the bowel wall and potassium and bicarb are excreted |
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Term
| 2 types of continent diversion |
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Definition
1. a diversion where a catheterizable stoma is created
2. where a neobladder or internal pouch is created |
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Term
| complications related to continent diversion |
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Definition
difficulty catheterization or stricture formation
failure to cath at appropriaye intervals may cause pouch rupture (medical emergency)
A complication specific to the use of a colon as the resivoir is colon cancer |
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Term
| a continent diversion with a neobladder |
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Definition
| involves creating a new bladder from a portion of the ileum and colon that's located where the bladder used to be |
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