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research in female patients. In addition to qualified practitioners within their scope of
the significance of organ and nerve removal practice and who possess the knowledge,
as part of the surgery, patients will need skills, and judgment to perform stoma
counselling for the changes in body image. site marking–a surgeon or NSWOC are
recommended. The 2009 American Urology
It is normal for patients to have concerns Association (AUA) and Wound, Ostomy,
about the changes in their body prior to and and Continence Society (WOCN Society)
after urinary diversion surgery including the position statement considered both fecal
way they will urinate. It is also normal for a and urinary diversions. Stoma site selection
patient to be concerned about how a urinary should be a priority during the preoperative
diversion might affect their sexuality and visit. Urologists and nurses with training in
their sexual relationships. Patients should be ostomy care are the optimal providers to mark
encouraged to contact their urologist, urology stoma sites, as this is part of their education,
team or NSWOC. practice, and training. The International
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Ostomy Association advocates that all persons
Sexual relations may be resumed when undergoing surgery should have a well-
approved by the urologist and when the constructed stoma placed at an appropriate
patient feels physically and emotionally site, with full and proper consideration of
ready. It takes time for the body to recover patient comfort. 11
from surgery and to adjust to the changes in
the body. Patients should discuss treatment Patients choosing a continent diversion such
options for erectile dysfunction or sexual as an Indiana pouch or neobladder should
dysfunction with their urologist, urology team also have a preoperative stoma site selected
or NSWOC. The Canadian Cancer Society and marked for an ileal conduit in the event
provides a valuable webpage Sex, Intimacy the continent diversion is not feasible.† For
and Cancer https://cancer.ca/en/cancer- neobladder and Indiana pouch diversions,
information/resources/publications/sex- some centres or surgeons may insert a
intimacy-and-cancer. In some cases, patients Malecot or suprapubic catheter and marking
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may benefit from referral to a professional should be undertaken to ensure adequate
specializing in sexual counselling. abdominal surface area is available to
accommodate a two-piece pouching system
Preoperative stoma site marking for irrigation.
The recommended urinary diversion option
must consider fine motor dexterity, renal
function, cognition, potential memory loss,
as well as the patient’s typical range of
physical movements related to their mobility,
occupation, lifestyle, and cultural practices.
NSWOCC published a detailed position
statement on preoperative stoma site
marking for fecal diversion in 2020. Many of
those aspects are common to each urinary
diversion. Preoperative stoma site selection
and marking must only be undertaken by
CANADIAN URINARY DIVERSIONs POSITION STATEMENT 12 12
