STOMAL THERAPY NURSING PRACTICE

Stomal Therapy Nursing Practice

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Stomal Therapy Nursing Practice

The ileal conduit has been the prime technique for urinary diversion for more than 50 years, and continues one of the simplest, safest and most common types of urinary diversion after fundamental cystectomy. Despite the widespread use of ileal conduits in urinary diversion, complications related to stomas are poorly described despite the relatively high incidence of 25% to 60%.1 Stomal complications are the most frequent reason for reoperation after cystectomy and represent a major factor influencing the quality of life in patients who have undergone urinary diversion.[1] and [2] Unfortunately there are few studies examining prevalence, risk factors and underlying causes associated with such complications. Therefore, in this study we examined the incidence and associated factors of stomal difficulties in patients undergoing fundamental cystectomy with ileal conduit urinary diversion for bladder cancer.

In agreement with the principles and practices of the University of North Carolina Institutional Review Board, and in acknowledgement of and compliance with HIPAA guidelines (United States wellbeing protection Portability and responsibility Act of 1996), a retrospective journal review was performed. We recognised 137 patients who had undergone ileal conduit diversion after fundamental cystectomy for bladder cancer from 2001 to 2005, who had entire clinical followup and who were followed for at least 12 months after surgery.

All patients underwent preoperative evaluation by a Wound Ostomy Continence Nurse. Preoperative stoma assessing was based on patient skin creases and bony structures, and established within the belly of rectus abdominis muscle. The location was furthermore assessed where the patient could visualize the stoma and supply self-care.3 In all patients the urostomy was conceived with a segment of ileum (15 to 20 centimetres) encompassing at smallest 1 large vascular arcade with a palpable pulse within the mesentery. The ureteroenteric anastomosis was presented using 4-zero polyglactin suture in an cut off latest trend for a Bricker anastomosis or in a running latest trend for a Wallace anastomosis.

The urostomy was then created. After a circular skin incision was made in the overlying skin, blunt and sharp dissection was carried down to the level of theabdominal wall fascia, excising any excess subcutaneous fatty tissue. Acruciate incision was made in the fascia and a muscle splitting dissection carried through the belly of the underlying rectus muscle. The ileal conduit was then dragged through this defect (widened to accept 2 fingerbreadths) and protected to the fascia with 2-zero polyglactin 4-quadrant sutures. The urostomy was everted and matured using 2-zero polyglactin suture placed on the subcuticular, serosal and mucosal brim in a 4-quadrant rosebud fashion. Any little defects between the skin and urostomy were shut with 3-zero polyglactin sutures. Before abdominal closure the peritoneum was closed over the conduit to retroperitonealize the proximal end and the ureteroenteric anastomoses.

In this study parastomal hernia was characterised as any factual fascial defect with bowel and overlying peritoneum protruding through the gap between the ileal segment and abdominal muscles leading to a swell at the groundwork of stoma.4 In all situations of suspected parastomal hernia, computerized tomography or magnetic resonance imaging of the abdomen was got to direct in (or direct out) the diagnosis. Stomal stenosis was characterised as constricting of the stoma at the skin or fascia leading to weakened drainage.3 Stomal prolapse was characterised as a significant boost ...