Continent Urinary Diversion eg Mitrofanoff This surgery avoids the need to wear a urostomy pouch over the stoma to collect the urine. Instead a small stoma is created and a catheter is passed into a reservoir (or the natural bladder) to drain the urine. The person having the operation must be highly motivated to accept this procedure. Good dexterity is required and a firm commitment to take care of the reservoir. As there is no other way of draining the reservoir a catheter must be passed at regular intervals, usually four hourly. Paul Mitrofanoff developed a continent urinary stoma mechanism in 1980. A urinary reservoir is fashioned from bowel, or the person’s own bladder may be used as the reservoir. A channel is fashioned from the appendix, ureter or ileum. The diversion is continent because of the valve arrangement, which prevents urinary leakage. The channel connects the reservoir to the abdominal surface. A small catheterisable stoma is placed in a cosmetically suitable site. It is important that the person is able to see the stoma in order to insert the catheter easily. Pre-operative care This is major surgery and investigations such as blood tests, chest x-ray, electrocardiograph and a kidney scan or an x-ray may be performed. You wil be admitted the day before surgery and if a new reservoir has to be fashioned out of bowel the surgeon may request some bowel preparation to clean out the bowel before surgery. Post-operative care
After the operation you may spend a short time in intensive care, but in
many units patients usual y go straight back to their wards. When you
wake up, you wil be aware of a number of tubes attached to your body.
Do not be alarmed as they are al part of the treatment. It may be a good
idea to warn your visitors of this beforehand.
You wil be given fluids through a drip, either in your neck or arm. You
may also have a method of pain control, which is usual y a button to press.
This releases medication into your body to ease any pain you may
experience and make you more comfortable. In some centres a
Specialist Nurse wil monitor your pain control and adjust it as necessary.
You usual y have a drain from your abdomen, to get rid of excess fluid
from the operation site. A large drainage tube wil drain the new
reservoir. The reservoir wil be irrigated several times a day to prevent
any blockage of the tubes. Two fine tubes (known as ‘stents’) wil also be
inserted alongside this tube. These wil be removed after about ten days.
Some surgeons al ow smal amounts to eat or drink the day fol owing
surgery. The amount wil be increased once your bowel starts working again.
The Physiotherapist wil also visit you to show you how to perform
deep breathing exercises and leg exercises to prevent any complications. also visit you to
You are usual y al owed to sit in a chair the day after your operation
show you how to
and then gradual y mobilise more each day. It is very important that you
perform deep breathing exercises
move around as much as possible, to prevent complications such as blood
and leg exercises to
clots. You wil probably be given injections to thin your blood whilst you
are in hospital. These also help to prevent blood clots from forming. complications.
It is also important to drink plenty of fluids. You may not feel like
eating too much at first, but nutrition is very important for wound
healing and regaining your strength.
You have had a major operation and consequently wil experience
some discomfort and weakness and also feel very tired. However, you
wil gradual y feel the improvement in your body. Care of your new reservoir
You wil be shown how to irrigate your reservoir before you go home.
You wil be al owed home for a few weeks with the drainage tube stil
stitched into your reservoir. It must be irrigated once or twice a day,
depending on how much debris is removed. A Community Nurse wil
When you return to hospital, the tube wil be removed and you wil be
shown how to drain the reservoir with a catheter. The procedure must
be performed as clean as possible to avoid any infections. If a new
reservoir has been created, a long male length catheter must be used, to
make sure it goes to the bottom of the reservoir. If the natural bladder is
being used, a female length catheter would be adequate for drainage. If it
is not drained completely you may be prone to urine infections or stone
formation. If the reservoir has been constructed from bowel, mucus wil
be produced. Regular washouts may be recommended to flush out the
mucus. Initial y you wil have to drain the reservoir at very frequent
intervals, starting with two hourly, whilst the new reservoir stretches to its
capacity. Usual y the reservoir is drained at 3–4 hourly intervals. Once
ful capacity is reached, it may be possible to go 6–7 hours overnight.
Catheters with special lubricated coatings for easier insertion are
used once only and then discarded. Your Specialist Nurse wil show you
the different types of catheter available.
A high fluid intake is necessary, at least two litres daily, to prevent urine
infection and stone formation. The stoma may produce a little mucus
and if required a smal dressing may be placed over the stoma site to
absorb the mucus. A dressing may also prevent friction from your
clothes. The dressings are available on prescription. You may obtain
them from your local pharmacy or a delivery company, who wil provide
you with free wipes and disposal bags. Some also provide a suitable
container to keep spare catheters in when you are out and about. Urinary infections Cranberry
If you start to develop a urine infection, your urine wil become cloudy
in any form must
and have an offensive smel . Increase your fluid intake. If you begin to feel
not be taken if you
feverish, with abdominal and kidney pain, col ect a urine specimen with a
are on Warfarin.
new catheter and take it to your GP, who wil prescribe antibiotics. A daily
glass or two of cranberry juice or capsules are beneficial in breaking down
the mucus. High doses of Vitamin C also help to maintain an acidic urine.
You wil stil feel very weak when you return home, but each day you
should feel stronger. Do not take to your bed! Exercise is very important
in helping to regain your stamina and strength. Your body wil tel you when
you need to rest. However, an afternoon nap is recommended. Try to get
out in the fresh air for a while and increase the distance walked each day. Nutrition
Your appetite may be slow to return after surgery and nutritional
supplements may be recommended. A normal healthy diet is
recommended to assist you in regaining your strength. You must drink
at least 2 litres daily, 3 litres in hot weather. This should be mainly water.
As part of the bowel has been operated on to create the reservoir,
bowel function may be disturbed initial y. With a high fluid intake and
plenty of fresh fruit and vegetables, your bowel actions should soon
become regular. If they don’t, you should inform your Consultant. Follow up NOTE This
Your Consultant wil make arrangements for your check-ups. These wil
information has been written as a guide to
be more frequent initial y, but then usual y once a year. A blood test wil
what may happen
be taken to check your kidney function and every few years a kidney
when continent urinary pouch surgery is performed. Important points to remember Remember that
• Empty your new reservoir at the recommended intervals
procedures differ in various urology units.
• Drink plenty of fluids – at least 2–3 litres daily• A Medic-Alert pendant or bracelet is advised,
especial y if you intend to travel abroad. For more information contact UA National Secretary Hazel Pixley 4 Demontfort Way . Uttoxeter . Staffordshire ST14 8XY )01889 563191 or 08452 412159 [email protected]
AN INTRODUCTORY OVERVIEW ON THE RESEARCH FROM MEDICINE TO Venerable Professors, PhD Scholars, Dear Colleagues, Distinguished Guests, Ladies and Gentlemen, Welcome to the First European PhD Conference, entitled From Medicine to Bionics, which covers the fields of medicine, molecular biology, medicinal chemistry, pharmacology, nano-scale opto-electromagnetics, electronics and computing, and neur
REVISTA ACADÉMICA DE LA FEDERACIÓN LATINOAMERICANA DE FACULTADES DE COMUNICACIÓN SOCIAL La Guerra en la Frontera llega a las pantallas televisivas: el tema de inmigración indocumentada a Estados Unidos Silvia Alvarez Curbelo Ph.D. Escuela de Comunicación - Universidad de Puerto Rico [email protected] De un modo más general, creo que la retórica va a ser una disciplin