Page 12 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

or less frequently constipation; 23,24 • offer peer support;
• the ability to sleep and reposition will • if an appropriate peer is not available
change depending on whether the locally, contact the paediatric ostomy
diversion includes a stoma, a night group; and
drainage bag, or the need to catheterize • provide parents/significant others
to empty the neobladder or pouch. with support to help them support the
Inadequacy of sleep also exacerbates adolescent living with a stoma.
psychosocial well-being; 25
• intimacy and sexual health encapsulate Patients with a higher body mass index (BMI)
many related factors, such as sexual are more likely to encounter leakage from
desire, body image, ability to have sexual a pouching system. The result is increased
intercourse, sexual function, or erectile emergency department visits and hospital
dysfunction; readmissions. In situations where poor pouch
• how to manage pouching systems and look adherence and pouch leakage is anticipated,
for possible complications; and ensure patients have a follow up with an
• impairment on relationships. 13,21 NSWOC 2 weeks postdischarge to examine
the stoma and ensure appropriate fit of the
Several authors have compared facets of pouching system. 31,32 In more rural settings,
HRQOL for different urinary diversions. Most the use of virtual visits may be required.†
studies have found no difference in HRQOL
across different diversions. In some studies, Patients with neurogenic bladder are at
patients with neobladders reported higher highest risk for long-term complications,
scores for body image and ability to partake particularly upper urinary tract deterioration.
in sport activities. 26-28 Zahran et al, (2016) Those at risk include individuals with spinal
notes that research on HRQOL in women cord injury, myelomeningocele, transverse
after radical cystectomy is lacking. One study myelitis, and other conditions in which there
asserts “In women, HRQOL is better after is a high burden of spinal disease. Evaluation
orthotopic urinary diversion than ileal conduit of the patient with neurogenic lower
as long as continence status is preserved. If urinary tract dysfunction should involve an
incontinence is expected, ileal conduit may be assessment of the upper urinary tract, bladder
a better option” for a urinary diversion. The safety, continence status, and quality of life
29
impact of urinary diversion on sleep appears concerns. In the absence of randomized
33
contradictory and requires further study. trials, all studies are biased by patient-led
and physician-led preferences with regards to
Younger patients are especially self-conscious HRQOL.
about changes in body image and personal
identity. Williams (2017) describes the Sexual Health
recommendations for NSWOCs caring for Radical cystectomy removes many of
adolescents living with a stoma: 30 the reproductive organs in men and
• develop an understanding of individuals’ women. This could be a concern especially
usual coping strategies; for younger patients. Sexual function
• identify if avoidance/approach coping has preserving techniques can be employed,
been adopted for life events previously; including nerve sparing and organ-sparing
• assist the patient in identifying strategies approaches depending on patient and tumor
that will aid coping; characteristics. 34,35 There has been limited

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