Page 222 - Urological Health

required. It is held on securely by glue and a belt; however it can be dislodged at times. The urostomy
appliance is usually replaced every 3 days or as needed (Figure 4). An ostomy nurse is usually available
to help you with long-term care. The most common early and late complications are bowel and
ureteric obstruction.

A B C

Figure 4. What the ileoconduit and urostomy appliance looks like. A: Ileoconduit nipple protruding through wafer into
appliance bag with valve at bottom and appliance belt; B: Appliance hidden and supported by underwear; C: Appliance
hidden by clothing.
UNDER REVIEW

Continent diversion
Continent diversion can be orthotopic (placed in the same location as the normal urinary bladder) or
heterotopic (located else where). The initial form of this type of diversion was to place the ureters into
the side of the sigmoid colon (bottom section of the large bowel).The urine was stored with fecal waste
and expelled at the time of bowel movement (defecation). This type of diversion where the urine is
mixed with the fecal material has a higher risk of developing colon cancer and is now not usually
performed.
Now, the most commonly used portion of bowel for
continent diversion is the terminal ileum (last segment of
small bowel), the proximal (beginning of) large bowel or
a combination of both. The bowel has to be reshaped into
asphere toreduce pressure in the new bladder
(neobladder). If the urethra and the urethral valve
(sphincter) are preserved, then the neobladder can be
placed orthotopically (normal spot). One of the most
commonly performed neobladder is called a Studer (see
Figure 5).
If the urethra and valve have to be removed for cancer
control, then the neobladder is placed elsewhere with a
one-way valve stoma (opening) that is catheterized to
allow drainage. The one-way valve can be hidden in Figure 5. A Studer neobladder (orthotopic).
A detubularized small bowel (ileum) being
the umbilicus (belly-button) or located elsewhere (see sutured closed attached to urethra. Bowel is
Figure 6). folded to produce a sphere to store urine at
the lowest possible pressure.

223