Ua leaflet a5

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 Physiotherapist will
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 prevent any
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. Recovery period
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]

Source: https://www.urostomyassociation.org.uk/wp-content/themes/Evolution/images/pdf/Continent%20Urinary.pdf