Page 6 - CANADIAN URINARY DIVERSIONS POSITION STATEMENT

Introduction

Surgical creation of a urinary diversion is necessary

for managing diseases affecting the urinary tract: such
procedures can be life altering. An intestinal urinary
diversion is a general term used to describe the elimination

of urine often through a surgically constructed intestinal
segment.

Urinary diversions can be incontinent or continent. An incontinent urinary
diversion allows a continuous passage of urine to exit to the surface of the
skin. The urine is captured and contained in an exterior disposable urinary
pouching system. A continent diversion permits control of the elimination
of urine through a catheterizable abdominal stoma or via the native urethra.
The specifics of each urinary diversion, as well as the patient considerations,
will be discussed throughout this position statement.

There are both benign and malignant indications for a urinary diversion. Most
commonly this is due to malignancy but less commonly this may be required
for severe bladder dysfunction, pyocystis, incontinence, bladder pain or
congenital abnormalities. While not all urinary diversions are related to
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oncological treatment, bladder cancer is a leading cause for cystectomy and
urinary diversion creation. Bladder cancer is the fifth leading cause of new
cancer cases and has shown a slight downward trend in mortality rate. A
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radical cystectomy is a standard treatment for invasive bladder cancer. 3

The rationale for the position statement
The purpose of this national position statement is to support health care
professionals, including surgeons, nurse specialized in wound, ostomy, and
continence (NSWOC) and urology nurses with the delivery of standardized
clinical best practices for the pre- and postoperative care management of
patients undergoing a urinary diversion. Through this position statement, we
have the opportunity to reinforce the fundamental principles enabling health
care practitioners to educate and counsel patients on the various urinary
diversion options.

Despite multiple texts, articles, and guidelines describing the nuances of
urinary diversions, there is a void in Canadian recommendations contrasting
the five principal urinary diversions. Refer to Table 1 for a quick reference
guide to the five urinary diversions discussed. The methodology is described
in Appendix A.

CANADIAN URINARY DIVERSIONs POSITION STATEMENT 6 6