Ostomy v Urinary Diversion- the whys and hows

Kevin RN08 · Oct 25, 2008

There is continant urinary diversions, a Koch's pouch is made from a section of bowel to form a "bladder" it's usually emptied Q2H.

Not to be judgemental, but the questions you're asking are probably answered by your textbook. I'm sure you will find the answers while you are pre-reading for class.

cminmd · Oct 25, 2008

Not to be judgemental, but if you can build a pouch for urine that doesn't leak, why can't you build a pouch for feces that doesn't leak? Just by the viscosity of the two samples you would think that it would be harder to keep a liquid from seeping than a runny or semi-formed solid.

And no, my text book does not cover it that is why I asked. The text book makes it sound like the majority of patients would not have ostomies. It implies the only patient who would get an ostomy is someone who had rectal cancer or diseased rectal tissue, but I have seen so far that many patients without cancer, or highly placed UC or Crohns still get ostomies. The book says

""Patients with UC may also need to have a total proctocolectomy. In both situations the surgeon will form an ileal pouch anal anastomosis. If the anal sphincters are not diseased they can be left intact, if not the person will need to have a permanent ileostomy."

I was just wondering why the book (which I know is highly theoretical) is so different from what I see in practice. I was wondering if EBP showed that leaving any portion of the intestine makes relapes more likely? pointed to the n is that the disease will spread anyway so might as well remove it all?

Thanks for you help, you make me feel so welcome.

Kevin RN08 · Oct 25, 2008

I evidently was insensitive to your question, my apologies. But I didn't see the questions raised in your second post in the first post. If you look at my posting history I am not a judgemental person (or poster), few if anything I've posted would offend anyone. Secondly, too often folks post questions here expecting others to do the work for them, you've seen the posts "What's a good NCP for XXX", and such.

From my own reading, whether to use a continent or incontinent ostomy depends on what the medical problem is, where the problem it is in the bowel (obstruction), how much good bowel is remaining, whether it is a permanent or temporary solution. UC is a progressive dz that spreads from the rectum continually through the colon, whereas Crohn's effects both the lg and sm intestines and lesions have no pattern of progression. In both cases the disease would spread to the "continent" pouch raising the prospect of rupture and potential peritonitis.

Some pts with diverticulitis will have temporary ostomies to allow for the inflammation heal, and then have the colon ends reconnected when sufficient healing has taken place (9-12months).

Hope this help some.

Maybe post in the General Board or under the specialties tab.

Dianacabana · Oct 25, 2008

What text are you using, Kevin? I'd be interested too in following up on some of the excellent questions brought up by the OP. Its not in either of my texts (Jarvis or Taylor).

Thanks!

Kevin RN08 · Oct 25, 2008

Lewis 7th Ed. Chapt. 39 - 43, plus some similar content that I have in my notes from class.

cminmd · Oct 25, 2008

No worries, Mate!

I have Lewis as well, but maybe they consider that information more "diagnosis" and out of our sphere of practice, but it seems like that is the type of questions patients would ask a nurse "in the room". The only ones I have seen that are to be reattached later are the double ostomy cases, but I have only seen one and that was for a gun shot victim, not due to a disease process. That is why the lewis comments seemed very atypical to me. I was wondering if in the real world- disease is full removal, but trauma is reversible? I don't know.

Daytonite, BSN, RN · Oct 25, 2008

first- why does a urinary diversion not drain out continually, but a fecal ostomy does?

i think this is just related to your individual experience and what you have observed. a urinary diversion should drain continuously. drainage may have been impeded due to the patient's position. not all fecal ostomies drain continuously.

also, why is their so much variations between ostomies. some are huge and protude, others are much smaller and only slightly humped. is that surgical skill or what accounts for the difference?

it depends on what the circumstances of each case and what the surgeon has to work with. perhaps there was a problem with healing.

also placement. i know that placement depends on which area of the intestine is damaged, but does placement site make some ostomies better or easier for patients?

placement of the colostomy depends on what area of the colon is being removed or bypassed. the surgeons do attempt to bring the ostomy out to an easy access for the patient. the surgeon, again, works with the situation they are presented with.

the text book makes it sound like the majority of patients would not have ostomies. it implies the only patient who would get an ostomy is someone who had rectal cancer or diseased rectal tissue, but i have seen so far that many patients without cancer, or highly placed uc or crohns still get ostomies.

this is done to rest the bowel and give it a chance to heal. this is done for crohn's and massive traumas. after healing, a "take down" or reversal is done to reconnect, or anastomose, the two ends of the bowel again.

http://www.surgeryencyclopedia.com/ce-fi/colostomy.html - the surgery

http://www.c3life.com/ostomy/ - patient support

http://www.colostomyassociation.org.uk/ - patient support

Dianacabana · Oct 25, 2008

Daytonite, will you please come teach at my school? This is amazing information. I can't wait to share it with my class mates.

THANK YOU!!