Page 10 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

SECTION 1 - PREOPERATIVE COUNSELLING

& HEALTH-RELATED QUALITY OF LIFE CONSIDERATIONS

Each of the sections that follow describe some of the

specific preoperative considerations for the relevant urinary
diversion. However, many of the aspects are common to the
continent versus incontinent diversions, or those requiring a

stoma versus catheterization.

In each case, meeting with an NSWOC, a nurse specialized or experienced
with urinary diversions, or a genitourinary nurse is regarded as imperative
to optimize patient outcomes and reduce avoidable complications. The
information provided will improve the patient’s knowledge, understanding
and comprehension to give an informed consent. These meetings will explain
the anatomy of stoma creation, stoma characteristics, stoma care, pouching
supplies, problems that may arise with the stoma, and signs of a urinary tract
infection (UTI). Stoma site marking is also an imperative component of this
consultation. Ali et al. (2015) notes that “Appropriate counselling regarding
the type of urinary diversion and its effect on physical activity and body
image remains an important aspect of preoperative discussion.” 6

In this section, we explore:
• patient education, counselling, and culture;
• health-related quality of life;
• sexual health;
• preoperative stoma site marking;
• enhanced recovery;
• postoperative follow up; and
• funding.

Patient education, counselling, and culture
A thorough patient assessment evaluates the overall health of the patient
and their comorbidities, which in conjunction with appropriate imaging
will help to determine the urinary diversion best suited for the patient. The
choice of urinary diversion has a significant impact on long-term quality of life
for patients who undergo radical cystectomy. “Discussing the pros and cons
of each approach is an essential aspect of preoperative education.” This can
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help ensure that the patient and significant others have realistic expectations
regarding each option.

CANADIAN URINARY DIVERSIONs POSITION STATEMENT 9 9