Page 21 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

Patient selection An Ottawa Hospital Research Institute patient
“Ileal conduits represent the fastest, easiest, decision aid, known as the Ottawa
least complication-prone, and most decision tool, facilitates guiding patients on
commonly performed urinary diversion” the choice of urinary diversion in the
57
as per Lee et al. (2014), and the primary preoperative phase. It is based on the
diversion for elderly patients. Consequently, International Patient Decision Aids Standard
54
candidates for ileal conduit tend to have (IPDAS) development process. It can be
more comorbidities, higher BMI, and poorer accessed here
health. 55 https://decisionaid.ohri.ca/docs/das/Surgery_
for_Bladder_Cancer.pdf. Figure 3 shows
Not all patients are suitable candidates for an element of the decision tool, which is
an ileal conduit diversion. Patients need to designed to help guide patients through the
be willing to accept having a stoma on their decision making on whether to opt for an ileal
abdomen and wearing a pouching system conduit or neobladder. The interprofessional
to collect their urine. Patients and their team is encouraged to utilize the validated
significant other also need to have adequate tool with their patients as part of the
manual dexterity, motivation and preoperative education and counselling.
understanding to reliably manage their
pouching system and nighttime drainage. 1,56

Figure 2 The Ottawa decision tool assists patients in choosing between an ileal conduit
and neobladder 57

INTERNAL BLADDER REPLACEMENT (Neobladder)
• The bladder is removed and a long (40-60 cm) piece of intestine is used
to create a substitute bladder.
• The ureters (tubes that connect kidney to bladder) are connected to one
end of the substitute bladder and the other end is brought down and
connected to the urethra (tube you urinate through).
• You will pass urine from the urethra, though it may take some time to
learn to pass urine this way and to gain control of your urine.

ABDOMINAL STOMA (Ileal Conduit)
• The bladder is removed and a short (15-20 cm) piece of intestine is used
to create a stoma to carry urine out of the body.
• The ureters (tubes that connect kidney to bladder) are connected to one
end of the piece of intestine and the other end is brought to the skin to
create an opening (stoma) near the belt line.
• Your urine will continuously flow out of the stoma into a bag which is
attached to your skin and under your clothes. The bag will need to be
emptied regularly.

Note. Reproduced with permission of the author

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