Question

The surgical management of the client with bladder cancer involves removal of the bladder and creation of a urinary diversion. Which statement describes an ileal reservoir? A. Urine is diverted directly to the skin surface B. Urine is diverted through a portion of the intestine to the skin surface C. Urine is diverted directly to the large intestine D. Urine is diverted into a surgically created pouch

Short answer

The correct description of an ileal reservoir is: Urine is diverted into a surgically created pouch (using a part of the small intestine).

Step-by-step solution

Understanding the options

Before addressing the ileal reservoir concept, let's briefly explain each option: A. Urine is diverted directly to the skin surface: This type of urinary diversion is called a cutaneous ureterostomy. In this procedure, the ureters are brought directly to the surface of the skin, creating a small opening (stoma) for the urine to drain. B. Urine is diverted through a portion of the intestine to the skin surface: This refers to a procedure called an ileal conduit. A small piece of the small intestine (ileum) is used to form a tube-like pathway for the urine to drain from the ureters to a stoma on the skin surface. C. Urine is diverted directly to the large intestine: This procedure is called ureterosigmoidostomy and implies that urine drains into the colon. However, it is not commonly used due to the risk of kidney damage, infections, and other complications. D. Urine is diverted into a surgically created pouch: This refers to the ileal reservoir or neobladder urinary diversion. In this procedure, a portion of the small intestine is used to construct a pouch that stores the urine. The patient can then urinate in a more normal fashion, although it may take practice learning how to empty the reservoir completely.

Identifying the ileal reservoir

Based on the given options and their descriptions, the correct statement that describes an ileal reservoir is: D. Urine is diverted into a surgically created pouch (using a part of the small intestine).

Key concepts

Ileal Reservoir

An ileal reservoir, often referred to as a neobladder, is a surgically created pouch using a part of the small intestine. This procedure is usually performed after bladder removal in patients with bladder cancer. The primary purpose is to create a new storage area for urine inside the body. Unlike other urinary diversion methods, the ileal reservoir allows patients to empty urine in a more traditional method via the urethra, provided the nerves and sphincter muscles are functioning properly.

The neobladder mimics the bladder's function but doesn't have the same nerves that signal fullness. Patients typically need to learn a new method of urination, involving periodic and conscious bladder emptying to prevent complications. Although creating an ileal reservoir can provide a higher quality of life, it requires commitment from patients to learn how to manage it correctly.

• Provides an internal method for urine storage.
• Involves a learning curve to manage efficient urination.
• Designed for patients aiming for a near-normal lifestyle post bladder removal.

Urinary Diversion Techniques

Urinary diversion techniques are a key aspect of bladder cancer management, particularly when the bladder must be removed. There are several techniques used to manage urine flow permanently. These techniques are chosen based on multiple factors including cancer stage, patient's overall health, and personal preferences. They are designed to direct urine from the kidneys to a new storage location, either within or outside the body.

Some common techniques include:

• Ileal Conduit: Uses a segment of the small intestine to create a conduit for urine to drain through a stoma on the skin.
• Cutaneous Ureterostomy: Directs ureters to the skin surface for urine drainage via a stoma.
• Ureterosigmoidostomy: Redirects urine flow into the colon, though less common due to high complication rates.
• Ileal Reservoir (Neobladder): Creates an internal pouch for urine storage allowing voluntary voiding.

Choosing the right technique involves close consultation between the surgeon and the patient, to ensure alignment with post-operative goals and lifestyle adjustments.

Surgical Intervention in Oncology

Surgical intervention in oncology, particularly for bladder cancer, involves complex decision-making and skillful execution. The primary goal in the case of bladder cancer is the removal of malignant tissues while preserving as much urinary function as possible. Bladder cancer surgery often involves removing not just the bladder but surrounding tissues and may include creating urinary diversions.

It's critical that oncological surgical procedures are done by experienced surgeons due to the complexities of human anatomy and the intricacies involved in not just removing cancer but also setting up a functional urinary diversion. Post-surgical care is paramount to mitigate risks and monitor for recurrence. This can include regular CT scans, lab work, and physical exams.

• Emphasizes the importance of removing cancerous tissues while restoring urinary function.
• Involves highly specialized surgical procedures depending on the cancer's stage and location.
• Requires post-operative vigilance to ensure patient recovery and cancer monitoring.

Patient Education on Urinary Diversion

Education plays a vital role in helping patients adjust to life with a urinary diversion. After surgical procedures like the creation of an ileal reservoir, patients need ample information to manage their new bladder efficiently. This includes understanding how to avoid complications and recognizing signs that might need medical attention such as infections or blockages.

The educational process should cover:

• Correct stoma and skin care techniques to prevent infections and irritation.
• Training on how to empty an ileal reservoir, which may initially require catheter use.
• Dietary and lifestyle adjustments to maintain optimal urinary system health.
• Guidance on managing psychological and social challenges associated with having a urinary diversion.

Continuous support from healthcare providers, including nurses and specialists, enhances patients' ability to adapt and achieve independence in managing their condition.