Page 15 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

Abridged steps Cont’d
iii. Select a stoma site preferably within the right lower quadrant, within the rectus
abdominis muscle, free of skin folds and scars, and visible to the patient.
b. For a cutaneous ureterostomy–choose a site in the lateral abdominal area, free of skin
folds and creases.
c. For a neobladder–some institutions prefer to have the Malecot, or suprapubic
catheter site marked to ensure adequate abdominal space to accommodate a two-
piece pouching system.
d. For a Mitrofanoff, the umbilicus is often the preferred location.
Note: If a neobladder or Indiana pouch is the preferred urinary diversion; explain to the
patient that they also need to be marked for an ileal conduit as well; should their first choice
of diversion not be surgically possible.
3. Confirm and mark the most appropriate site(s). Obtain agreement from the patient about
the recommended location. Cleanse the area with alcohol: allow to dry. Mark site using a
mark with a single patient use marker. This is typically an “X” or filled in circle depending
on local health care organizational policy. Cover with a transparent dressing.
Note: Depending on the patient’s body habitus or surgical procedure, it may be desirable to
mark several potential sites in different abdominal quadrants (right vs. left, upper vs. lower).
When two possible sites are marked, indicate the rank order of site preference; one preferred
and a second choice.
4. Discuss challenging site markings with a member of the surgical team. With patient’s
permission obtain photographs and add to electronic medical record (EMR) or email to
surgeon, according to organizational policy.

Enhanced Recovery After Surgery Published articles reviewed by Kelly et al.
The concepts of enhanced recovery have (2015) and Raynor et al. (2013) support
been applied to urinary diversions. According the view that bowel preparation is not
to work by Frees et al. (2018) patients necessary for radical cystectomy and urinary
undertaking the enhanced recovery pathway diversion in the uncomplicated patient. 39,40
after surgery had a significantly shorter In a systematic review and meta-analysis of
hospital stay, time to flatulence, and time randomized controlled trials, Feng et al. (2020)
to bowel movement and improved pain examined ERAS with ileal urinary diversion.
management with ERAS. 38 They concluded that ERAS might reduce
hospitalization expenses, contribute to a
The EAUN Incontinent Urostomy guidelines higher patient turnover, lead to more efficient
from 2009 highlight patients undertaking the utilization of medical resources and a lower
enhanced recovery program, who received risk of nosocomial infection as a result of a
no preoperative bowel preparation, had a shorter length of stay. 41
significantly reduced hospital stay with no
adverse effect on morbidity or mortality. 18 For centres utilizing an enhanced recovery
The research around enhanced recovery approach, patient and caregiver education
questions the traditional view for the of the care requirements and self-care
use of bowel preparation preoperatively. expectations for their specific urinary

CANADIAN URINARY DIVERSIONs POSITION STATEMENT 14 14