Page 16 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

diversion needs to be initiated in the and the geographical location of the individual
preoperative phase to promote self-care upon with an ostomy has a significant impact on the
discharge considering the reduced length of availability of resources. Assuming a price of
46
stay. CAD $30 for a two-piece pouching system with
a 4.8 day wear time, it is estimated individuals
An enhanced recovery checklist for an ileal are spending a minimum of CAD $1,560 per
conduit to standardize patient care and year. Despite considerable differences in
education is shown in Table 3. It is further funding bundles, out-of-pocket expenses are
reproduced in Appendix B as an enabler for the same across Canada. The costs associated
practice. with living with an ostomy contribute to
substantial financial burden exacerbated by
Postoperative follow up people with an ostomy who could be unable
This position statement does not discuss to resume full work duties. Furthermore, the
postoperative complications beyond noting authors noted that access to an NSWOC can
there is an elevated risk of urinary tract potentially reduce peristomal complications
infections–both bacterial and fungal. 42 and aid in cost containment. 46
Urolithiasis (stones formation) can be
mitigated by advising the patent to routinely Based on an assessment of provincial funding
irrigate the bladder or pouch to clear out programs by Spinal Cord Injury Ontario,
mucous. 43,44 most Canadians do not have access to
reimbursement for intermittent catheters.
Klein et al. (2021) noted the reluctance Assuming use of four clean catheters per day,
of patients to discuss concerns with their people living with a Mitrofanoff, or other
physician. Armed with that knowledge, an bladder diversions requiring catheterization
12
NSWOC or urology nurse should schedule will spend $1,022 to $5,840 per annum on
early and frequent surveillance. Education catheters. Many people are forced to reuse
should be personalized to address patient- their intermittent catheters, a practice not
centred concerns, including complications and recommended in recent Clean intermittent
correct application of pouches. Peristomal urethral catheterization in adults – Canadian
skin complications can be a debilitating and best practice recommendations for nurses. 47
painful impacting patients’ psychosocial well-
being and extend their recovery. Education in
the correct application of pouches to avoid
skin complications is vital. Regular lifelong
45
urological follow up is essential for all patients
who have a urinary diversion.

Funding
There is a financial burden on the patient from
an ostomy or need for catheter supplies with
variations in accessibility and affordability of
supplies and support across the provinces/
territories. A cross-sectional survey by LeBlanc
et al. (2019) concluded that living with an
ostomy impacts Canadians financial well-being

CANADIAN URINARY DIVERSIONs POSITION STATEMENT 15 15