Urinary Diversion

Under supervision:
A.L: Abir Ashraf
 Outlines:

• Introduction
• Definition
• Indication
• Types
• Complications
• Risk factors
• Nursing role
• References

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Introduction:-
• Procedure is performed to divert urine from the bladder
to anew exit site, through surgical opening.
• The age of patient, condition of the bladder, body fluids,
degree of urethral dilation to participate in
postoperative care are all taken into consideration when
surgical procedure.
• This may be due to the bladder having to be removed
(cystectomy) or a malfunctioning bladder as the result of
bladder cancer, an enlarged prostate, injury to the
urethra, stones, injury to the urinary tract, or
conductions causing pressure on the urethra or ureters.

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Definition:-
It is a surgical procedure that creates a new way for urine to exit
your body when urine flow is blocked or when there is a need to
bypass a diseased area in the urinary tract.

Indication:-
1-Bladder cancer: Cystectomy necessitates diversion.
2-Birth defects: Congenital abnormalities like bladder
exstrophy.
3-Trauma: Severe injury to the urinary tract.
4-Radiation therapy: Extensive radiation treatment for pelvic
malignancies can damage the bladder.
5-Chronic inflammation: Conditions like interstitial cystitis or
tuberculosis can lead to irreversible bladder damage.
6-Neurological disorders: Conditions like spinal cord injury or
can disrupt bladder function.

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Types of urinary diversion:-
• There are three types of Urinary diversion surgeries:
1-Ileal conduit urinary diversion.
2-Indiana pouch reservoir.
3-Neobladder-to-urethra diversion.
For all of these procedures, a portion of the small and/or large
bowel is disconnected from the fecal stream and used for
reconstruction.
1- Ileal conduit urinary diversion:
• A segment of the intestine directs the Urine through a stoma
into an external collecting bag.
• In this procedure, the ureters drain freely into part of the ileum.
The end of the ileum into which the ureters drain is then brought
out through an opening in the abdominal wall. This opening,
called a stoma, is covered with a bag that gathers the urine as it
drains from the ileal conduit.

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Advantages:
1-There is no need for occasional catheterization.
2-It is A relativity simple surgery.
3-It requires less Surgical time.

Disadvantages:
1-There is a change in body image.
2-It uses an external bag to collect urine, which might leak or
have odors.

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2- Indiana pouch reservoir:
A pouch is made of portions of the intestines. It stores urine until
it is drained via a catheter inserted through the stoma.
In this type of surgery, a reservoir or pouch is made out of a
portion of the large intestine and a portion of the ileum. The
ureters are repositioned to drain into this pouch. The urine flows
freely in a downward direction from the kidneys into the pouch.
This positioning prevents urine from backing up into the kidneys,
which protects the kidneys from infection. A short piece of small
intestine is then brought out through a small opening in the
abdominal wall (a stoma). The stoma is very small and can be
covered with an adhesive bandage.
Advantages:
1-The risk for urine leaking is minimal.
2-Urine is kept inside the body.
3-No external bag is necessary.
4-The small stoma can be covered with an adhesive bandage.

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Disadvantages:
1-The surgery takes Longer compared with ileal conduit.
2-There is need for occasional catheterization.

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3- Neobladder-to-urethra diversion:
- The Intestine is made into a reservoir and connected to the
urethra.
- In This procedure most closely resembles the storage function of
a urinary bladder. A small part of the small intestine is made into
a reservoir or pouch, which is connected to the urethra. The
ureters are repositioned to drain into this pouch.
- Urine is able to pass from the kidneys, to the ureters, to the
pouch, and through the urethra in a manner similar to the
normal passing of urine. To empty the pouch, you need to
contract (tighten) your abdominal muscle.
Advantages:
1-The process of urination most closely matches normal
urination.
2-No stoma is needed.

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Disadvantages:
1-Surgery time is slightly longer than the ileal conduit urinary
diversion procedure.
2-Urinary incontinence is normal after surgery.
3-Despite the surgery, some people might not be able to empty
their bladder well and will need to perform occasional
catheterization for a prolonged period of time after surgery,
and perhaps permanently.

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Complications:-
1- Urine infection.
2- Formation of stone.
3- Urinary leakage.
4- Fluid collection.
5- Urinoma.
6- Hematoma.
7- Ureteral stenosis.
8- Herniation.
9- Tumor.
10- Renal failure.

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Risk factors of urinary diversion:-
• Patients with pre-existing conditions such as diabetes,
hypertension, or chronic kidney disease
• Obesity.
• Smoking.
• Advanced Age.
• Poor Nutritional Status.
• Previous Abdominal Surgeries.
• Radiation Therapy.
• Immunosuppression.
• Coagulopathies.

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Nursing role:-
1. Preoperative Care:
• Educating the patient about the surgical procedure, potential
complications, and postoperative care.
• Assessing the patient's understanding and readiness for
surgery.
• Collaborating with the healthcare team to ensure the patient
is medically optimized for surgery.

2. Intraoperative Support:
• Nurses assist the surgical team during the procedure by
preparing the operating room, positioning the patient, and
providing instruments and supplies as needed.

3. Postoperative Care:
• Monitoring vital signs, urinary output, and signs of infection
or complications.
• Managing pain and providing comfort measures.
• Assisting with wound care and monitoring for signs of healing
or infection.
• Educating the patient on self-care techniques, including
stoma care if a stoma is created as part of the diversion.

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4. Complications Management:
• Monitoring for common complications such as urinary tract
infections, stoma complications, electrolyte imbalances, and
metabolic issues.
• Collaborating with the healthcare team to address any
complications promptly and effectively.
• Providing emotional support and reassurance to the patient
and their family members.

5. Patient Education:
• Teaching the patient about proper care of the urinary
diversion, including irrigation techniques, appliance changes,
and signs of complications.
• Providing information on dietary modifications, fluid intake,
and activity restrictions post-surgery.
• Addressing any concerns or questions the patient may have
about living with a urinary diversion.

6. Psychosocial Support:
• Assessing the patient's emotional well-being and providing
support as needed.
• Referring the patient to appropriate resources such as support
groups or counseling services.
• Encouraging open communication and addressing any fears
or anxieties related to living with a urinary diversion.

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References:-
1- Urinary Diversion
2- MORONEY's SURGERY FOR NURSES
3- medical surgical -nursing
4- https://www.bladderandbowel.org/
5- https://www.niddk.nih.gov/health-information/urologic-
diseases/urinary-diversion
6- https://www.urologyhealth.org/urology-a-z/u/urinary-diversion

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