URINARY DIVERSION

Non-continent Urinary
Diversion
Continent Urinary Diversion
those that have a stoma brought
out of the belly and those in
which a neobladder is made
4 or 5
bladder can no longer safely
function as a reservoir
Bladder cancer, Neurogenic
bladder, radiation injury
Bowel injured by radiation, poor
renal function, severe metabolic
abnormalities, proteinuria
60 ml/min

Conduit necrosis
Conduit ischemia
Conduit elongation
Pouch stones

1. Ileal conduit
2.) Nephrostomy
3.) Continent urinary
diversion

Continent urinary reservoir

Orthotopic bladder replacement

Antibiotics
standing, sitting and lying
3 wks
red, wet with mucus, soft, and
slightly rubbery
Cyanotic
blue-black or tan-brown
3-5 days
30 ml
8 hrs
1/10 to 1/8 in
3 days, 4 to 7 days

third to half
lower
bleed
4 to 6 hrs
30 ml
5 sec, 5-10 sec
15-20 times
Ureteroscopy
Remove kidney stones, urinary
tract infections, Examine a
growth or tumor, cancer
Infection, Bleeding, Injury to a
ureter
Untreated urinary tract infection
endoscopy without appropriate
antibiotic coverage
uncorrected bleeding diathesis
midnight
24 hrs
Percocet or Vicodin.
Urethral pressure profile test

To evaluate smooth
muscle activity along the
urethral wall.

diverting the urinary stream from the bladder so that it exits by way of a new avenue. can be
temporary or permanent, depending on the reason for the procedure.
involve linking the ureters to a piece of intestine that is brought out of the belly.
your surgeon will make a pouch inside your body from part of your intestines to hold urine.
2 basic types:

With a surgical stoma, you will need to insert a tube into the stoma to drain the urine _times a
day.
Purpose:
Indications

Contraindications:

Patients with a preoperative creatinine clearance of less than _ mL/min should not undergo
continent urinary diversion.
Complications:
acute ischemia to bowel segment
stomal stenosis or stricture
distal obstruction of stoma
Methods of Urinary Diversion
- or "Bricker's loop", most common; transplants the ureters into an isolated section of the
terminal ileum bringing one end through the abdominal wall to create a stoma
- insertion of a catheter into the renal pelvis by way of an incision into the flank or by
percutaneous catheter placement into the kidney
create a urinary reservoir from an intestinal segment that is either brought to the skin using a
valve mechanism that permits catheterization or is anastomosed directly to the proximal
urethra
2 Types of urinary reservoir:
a.) _(Kock pouch, Indian pouch, Main pouch)- transplants the ureters into a pouch created from
small bowel or large bowel.
b.)_ (Hemi-Kock pouch, Neobladder and others)- pouch created from small or large and small
bowel is anastomosed to urethral stump, voiding is through the urethra.
Preoperative Management:
_as prescribed
for ileal conduit, the stoma site is planned preop.when _ pos
stents will emerge from stoma or through separate wound (stents are not visible in orthotopic
bladder replacement patients) They are removed in_weeks.
Stoma should be _to touch
_stoma indicates poor circulation
Necrotic stoma is _
Initial urostomy pouch remains in place for several days postoperatively; it is changed every
_days
Maintain patency of drainage catheters placed into internal urinary pouch during surgery;
irrigate with _ mL saline every 2-4 hours to prevent obstruction from mucous accumulation
Monitor output of pelvic drain (on gentle suction or gravity drainage) every _ hours
The inside diameter of the skin barrier should not be more than _inch larger than the diameter
of the stoma
type of pou Position the drainage bottle lower than the level of the bed to enhance flow by
gravity
two- piece pouches)
Advise emptying the pouch when it is a _full to prevent weight of urine from loosening
adhesive seal
Position the drainage bottle _than the level of the bed to enhance flow by gravity
Teach that the stoma may _if it is bumped or rubbed
Teach irrigation of catheter; this must be done every _hours at home
Teach patient to irrigate Foley catheter that will stay in place for 3 weeks after surgery,irrigate
with _mL saline every 4-6 hours
contract pelvic floor muscles for _ seconds,then relax for _seconds
Repeat approximately _times for one set, and do three sets per day
procedure in which a small scope (like a flexible telescope) is inserted into the bladder and
ureter and it is used to diagnose and treat a variety of problems in the urinary tract.
Purpose

Complications
contra

You may be asked not to eat or drink anything after _ the day before your procedure
You will need to rest for _hours
You may be given narcotic pain relievers such as
the continual recording of pressure through a hole in the side of a small catheter as it is pulled
(at a constant rate, although either water or a gas is infused through the hole) from a point
within the bladder, through the vesical neck, and down the entire urethra
Purpose

Incontinence, Nerve injury

UTI
normal saline
puller mechanism
low-pressure urethra
BENCE JONES PROTEIN TEST
BENCE JONES PROTEIN
tumor marker
plasma
multiple myeloma
24 hrs
50-80%
penicillin or aspirin
NEPHROTOMOGRAPHY
Enable other organs to be
blurred out in order to better
visualize the kidney
Ability to visualize kidneys free
from intestinal content
imposition
renal calculi
Renal failure
Contrast medium sensitivity
liquids
24 hrs.
URETERAL PRESSURE
PROFILE
3F
URETOARRYHTHMIA.
15 min
silent
Transrectal biopsy
abnormal prostate
cancer
Kneel, Lie on his back with feet
resting on stirrups. May lie on
stomach
Local
Transrectal ultrasonography
6-12
30 min
Bleeding
Blood in urine
rust-colored
BPH
(Fine Needle Aspiration Biopsy)
analyze a mass, abnormal
tissue, kidney cancer, kidney
failure
UTZ
30-60 min
CNAB (Core Needle Aspiration
Biopsy)
solid
local
8 hrs
Allergic reaction, infection,
syncope
1-2 days

Indication
Complication
The bladder is filled with fluid such as_or water or with contrast medium using a catheter.
A _provides a slow, even rate catheter withdrawal while resistance exerted by the urethral wall
is registered as a pressure rise on a graph.
A_, a procedure that improves urethral closure is appropriate.
are small proteins (light chains of immunoblobulin) found in the urine.
diagnose and monitor multiple myeloma and other similar diseases.
the first tumor marker.
_is a substance, maybe by the body, that is linked to a certain cancer, or malignancy.
bence jones proteins are made by _cells
_- a tumor of plasma cells, is the disease most often linked with bence jones proteins.
urine is usually collected throughout a _hour time period
Abnormal: bence jones proteins are present in _of people with multiple myeloma.
high doses of _before collecting the urine can give a false positive result.
special procedure for the sectional representation of the parenchymal structures of the kidneys
by the use of tomography
purpose

INDICATIONS
CONTRAINDICATIONS
The day before the examination, the patient should stay on _or a light diet to decrease solids in
the colon
the result will be out within
continual recording of pressure through a hole in the side of small catheter (at a constant rate,
although either water or a gas is infused through the hole) from a point within the bladder,
through the vesical neck, and down the entire urethra
A _catheter is gently inserted through the urethra and into the bladder, and attached to a
machine that monitors pressure
The strictured moderately dilated ureter showed peristaltic waves with irregular rhythm and
pressure amplitude, called _
This test usually takes less than _minutes.
The hugely dilated ureter showed no waves, a _ profile.
A procedure in which a sample of tissue is removed from the prostate using a thin needle that
is inserted through the rectum and into the prostate.
when blood test shows a high level of PSA or after a digital rectal examination finds an _or a
lump.
The tissue samples taken during the biopsy are examined for _cells.
position

Anesthesia used
_is used to create images of the prostate using sound wave
_tissues samples are taken
Usually takes _ minutes
Inform patient that:
He may have some light _from his rectum
_or stools for a few days
Semen may have red or _tint(caused by the small amount of blood in the semen)
abnormal
biopsy of the kidney tissue is performed to evaluate kidney abnormalities, such as a kidney
mass, a kidney cyst, and for any other abnormalities that affects kidney function
indications

The procedure is usually performed using _technique or CT scan of the abdomen, depending on
the reason for performing the kidney biopsy
The biopsy procedure may take anywhere between _minutes.
hollow needle is inserted into the area of interest and cylindrical cores of the tissue are
removed.
Core needle biopsy is usually performed on a _mass.
Normally _anesthesia is used
NPO for _ hrs
Risks
Remove the bandage after _days