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Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
This is formed when the person’s lower urinary tract is malfunctioning. The most common cause is bladder cancer, where the bladder is removed. However, ileal conduits are also an option for individuals with intractable incontinence or post-pelvic trauma. The ureters are attached to a segment of small bowel (ileum), which is brought to the surface of the body forming a stoma, and draining into a urostomy bag. It is usually sited in the right iliac fossa or, though rarely, on the left.
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
For individuals with an ostomy (i.e. urostomy or colostomy), awareness of the presence of a stoma and collection pouch device is critical for the treating clinician. Patient education efforts should be geared towards the reduction of intra-abdominal pressure (IAP) through body mechanics training for the reduction of risk of hernia and improved stoma management. Caution should be taken with exercise prescription so as to avoid excessive pressure on the device or stoma, as well as with activities that are excessively jarring which may be poorly tolerated. Patients should avoid Valsalva maneuvers, which can force tissue out and back through the stoma, causing painful irritation and inflammation.
Anterior Component Separation
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Elizabeth Tweedle, James Wheeler
In patients whose stoma is not being removed, particular attention should be paid to the form of stoma and the length of bowel available for re-siting. End colostomies or ileostomies can generally be easily mobilised and refashioned at the end of the procedure, with additional length obtained by adhesiolysis during the laparotomy phase of the dissection. The stoma is dissected off the skin and stapled off initially to minimise contamination but left adherent to the muscular defect for now; if possible the same muscular aperture should be used for the stoma later to avoid creation of another site of weakness in the closure with the skin aperture re-sited as required to avoid kinking. Care must be taken to avoid creating devitalised skin bridges however, particularly in the context of a standard ACS. Urostomies pose a particular technical challenge, as they are short due to tethering posteriorly to blood supply and ureters. A urostomy should be prepared and catheterised with a 14-French urinary catheter with the balloon inflated with 5–10 mL of sterile water. Mobilisation of a urostomy from the muscular aperture is not recommended so as to avoid retraction and risk of injury to blood supply; instead, mobilisation is performed with urostomy in situ then skin detached and re-approximated at the end of the procedure if required.
Evaluating the cost-utility of intravesical Bacillus Calmette-Guérin versus radical cystectomy in patients with high-risk non-muscle-invasive bladder cancer in the UK
Published in Journal of Medical Economics, 2023
Kristin Grabe-Heyne, Christof Henne, Isaac Odeyemi, Johannes Pöhlmann, Waqas Ahmed, Richard F. Pollock
Bladder cancer was the 12th most common cancer worldwide in 2020.1 Non-muscle-invasive bladder cancer (NMIBC) accounts for between 70–75% of bladder cancers at the time of initial diagnosis,2 and can be further classified into low-, intermediate-, high-, or very high-risk disease.3 Treatment guidelines for high-risk NMIBC recommend patients undergo transurethral resection of bladder tumor (TURBT), followed by intravesical immunotherapy with Bacillus Calmette-Guerin (BCG).3,4 BCG is a live attenuated strain of Mycobacterium bovis that is administered into the bladder using a catheter and left in the bladder for 2 h, with weekly treatments for the first 6 weeks and, ideally, subsequent maintenance therapy, and with follow-up cystoscopies for the remainder of patient lifetimes.5 As an alternative to intravesical BCG, immediate radical cystectomy (RC) may be considered.3,5,6 This surgical procedure involves the complete removal of the bladder and surrounding tissues, followed by the creation of an ileal conduit (urostomy) or (orthotopic) neobladder to allow storing and passing of urine.7
Women’s experience of sexuality after radical cystectomy – a qualitative study
Published in Scandinavian Journal of Urology, 2023
Annica Löfgren, Karin Stenzelius, Fredrik Liedberg, Anne-Marie Wangel
The women described the post-RC period as involving both physical and mental recovery. The length of this period varied between the different individuals but ranged somewhere from a couple of months up to a year. Sexual rehabilitation included the return of desire and of sexual thoughts and fantasies. The women together with their partner made adjustments that facilitated sexual activities, such as adopting new positions of intercourse. This included how to deal with the urostomy and the uribag during the act, or other ways of enjoying sexual pleasure, on their own or together with their partner. The women described the importance of being given the opportunity to control at what point they felt ready to resume sexual life. In some cases, the women themselves had decided to resume sexual activities. The fact that their partner had let them do so in their own time was perceived as considerate on the part of the partner, and in some cases, there had been a discussion together with the partner. There was, for example, a greater need for planning and preparing for sexual intercourse or sexual activity than before and the women felt that the spontaneity had disappeared. After about three months, thoughts and questions about sexual aspects returned and at this point the women expressed a wish to have a post-operative visit, where this type of concerns could be discussed, and requested an approval to start sexual activity.
Surgical flap delay to allow primary transabdominal transplantation of extended rectus abdominis myocutaneous flaps in increasingly complex pelvic wound reconstructions
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Maurits Lange, J. Joris Hage, Arend Aalbers, Esther M. K. Wit, Frédéric Amant, Marije J. Hoornweg
Following the resection, the ERAM flap skin paddle was lifted from the oblique abdominal muscular fascia by the plastic surgeon. Necrosectomy of the tip was indicated in 27 flaps (0.26), resulting in a mean residual length of 28.2 cm (range, 20–42 cm; SD 4.99) of the 105 flaps to be transplanted (Table 2). The anterior lamina of the rectus sheet was opened circumferentially to the subcutaneous cuff protecting the perforators. We make a point of leaving enough of the caudal part of the anterior lamina to generously overlap with the linea arcuate of the posterior lamina in order to later allow double-breasted closure [7]. The rectus muscle was dissected caudally down to the level of its inguinal vascular pedicle. In four patients, a pre-existent colostomy (n = 3) or urostomy (n = 1) was temporarily taken down to allow dissection of the vascular pedicle ‘flush’ on the ostomy.