Page 33 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

Patient selection Preoperative stoma site marking is also
A patient’s dexterity and cognitive function a fundamental aspect of an Indiana pouch
must be assessed before consideration of diversion. An experienced NSWOC marking
an Indiana pouch as both factors need to the stoma site preoperatively is associated
be intact to care for the stoma and perform with less difficulty for the patient in adjusting
intermittent catheterizations. to the stoma and an improved HRQOL.
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The abridged preoperative site marking steps
An Indiana pouch diversion requires for urostomy are presented in Section 1.
good renal function. Hepatic dysfunction, The stoma site will be marked on the right
compromised intestinal function or serum lower quadrant with consideration of the
creatinine >1.7 µmol/L are contraindications. 1 beltline, skin folds and ease of visualization
by the patient. 1
Cheng et al. (2021) showed an increased rate
of stoma complications in patients with a Preoperative education at a minimum should
higher BMI. As well as higher rates of surgical include the following:
84
site infections and UTIs in comparison to those • anatomy of the stoma and preoperative
who received an ileal conduit or neobladder stoma site marking;
diversion. 84 • the role of stents;
• long-term commitment necessary for
An Indiana pouch diversion is a potential intermittent catheterization;
option for children, who have rare congenital • importance of hydration to dilute mucus;
bladder abnormalities, such as exstrophy • early signs and symptoms of infection
and epispadias, when repair has been that would be typical for a patient with
unsuccessful. In these patients, malignancy an Indiana pouch (flank pain, fever, foul
is not the causation. smelling urine, cloudy urine);
• normal appearance of mucus in the urine
Preoperative consultation and its presence from continued bowel
An Indiana pouch is a continent diversion mucus production;
with an abdominal stoma. Similar to other • stoma sensation (i.e., none), and reducing
urinary diversions, the patient and significant friction and trauma to the stoma;† and
others should be involved in the decision- • discussion of coverage of medical supplies
making process through education and needed postoperatively and where they
support provided by an NSWOC or urology can find a supplier in their community.
nurse. One main driving factor for choosing
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the Indiana pouch is the lack of an exterior Lifelong intermittent catheterization
physical pouching system. necessitates having the financial means
or health benefits to support the annual cost

An NSWOC or urology nurse can assess the of catheters.
hand dexterity of a patient to ensure they
will be able to perform self-catheterizing Early postoperative care
through their stoma. The patient must also be A patient with an Indiana pouch will have
cognitively intact and commit to following a a stoma on the right lower quadrant with
regular irrigation and catheterization schedule. a catheter in situ. Additionally, there will be
For patients with an Indiana pouch diversion, a Malecot or suprapubic catheter in the left
a referral to both Bladder Cancer Canada and lower quadrant and two ureteric stents.
Ostomy Canada Society may be worthwhile.† The stents maintain patency, ensure urine

CANADIAN URINARY DIVERSIONs POSITION STATEMENT 31 31