Our Summary

The research paper discusses the evolution of techniques in continent cutaneous urinary diversion (CCUD), a procedure used for patients who cannot use their urethra due to issues like incontinence, radiation damage, or cancer. The paper examines how these techniques have progressed over the last 30 years and how they are used in surgeries today.

In this procedure, a new reservoir is created using the patient’s bowel, which is shaped into a pouch for urine to be stored and then removed from the body. This process adheres to the basic principles of CCUD, which includes using parts of the intestine or the right side of the colon to make the pouch.

The article also looks at the history of CCUD, how patients are selected for the procedure, what happens before the operation, the surgery itself, and the results afterwards. It’s mainly focused on how this procedure can be used for bladder cancer patients.

FAQs

  1. What is continent cutaneous urinary diversion (CCUD) surgery?
  2. Who are the ideal candidates for CCUD surgery?
  3. What are the outcomes and potential side effects of CCUD surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urinary diversion surgery is to carefully follow all post-operative care instructions provided by your healthcare team. This may include proper wound care, managing pain medication, monitoring for signs of infection, and gradually resuming normal activities as directed. It is important to communicate any concerns or complications to your healthcare provider promptly to ensure proper healing and recovery.

Suitable For

Patients who are typically recommended urinary diversion surgery include those who have preexisting incontinence, radiation damage, or malignancy that prevents the use of the urethra for orthotopic diversion. This includes patients with bladder cancer who may require a continent cutaneous urinary diversion (CCUD) procedure such as the creation of an Indiana pouch or right colon pouch. These patients may undergo preoperative evaluation to determine if they are suitable candidates for CCUD based on their medical history, physical condition, and surgical risks. The surgical technique for CCUD involves creating a reservoir using detubularized bowel in a spherical conformation, typically using either ileum or the right colon. Overall, CCUD can be a viable option for patients who are unable to undergo traditional urinary diversion surgeries due to various medical conditions.

Timeline

  • Pre-surgery: Before urinary diversion surgery, the patient will undergo a thorough evaluation by a healthcare team, including a urologist and a reconstructive surgeon. This evaluation will include tests such as blood work, imaging studies, and possibly a cystoscopy. The patient will also receive counseling about the procedure and its potential risks and benefits.

  • Surgery: During the surgery, the urologist will create a new way for urine to leave the body. This may involve removing part or all of the bladder and creating a new pouch or reservoir using a section of the small intestine or colon. The surgeon will also create a stoma, or opening, on the abdomen for urine to be emptied into a pouch or collected in a bag.

  • Post-surgery: After the surgery, the patient will likely spend several days in the hospital recovering. The healthcare team will provide instructions on caring for the stoma, managing pain, and gradually resuming normal activities. The patient may also need to make dietary changes and learn how to empty and care for the pouch or bag.

  • Follow-up: The patient will have regular follow-up appointments with their healthcare team to monitor their progress, address any concerns or complications, and make any necessary adjustments to their care plan. With proper care and follow-up, most patients can resume their normal activities and enjoy an improved quality of life after urinary diversion surgery.

What to Ask Your Doctor

  1. What is continent cutaneous urinary diversion (CCUD) and why is it being recommended for me?
  2. What are the potential risks and complications associated with CCUD surgery?
  3. How long is the recovery period after CCUD surgery and what can I expect during this time?
  4. Will I need to make any lifestyle changes or modifications to my daily routine after CCUD surgery?
  5. What type of follow-up care will be required after CCUD surgery?
  6. How successful is CCUD surgery in terms of long-term outcomes and quality of life?
  7. Are there any alternative options to CCUD surgery that I should consider?
  8. How experienced are you in performing CCUD surgery and what is your success rate with this procedure?
  9. Are there any specific dietary restrictions or guidelines I should follow before or after CCUD surgery?
  10. Can you provide me with more information about the specific CCUD procedure that will be performed, including any potential modifications or variations that may be considered for my case?

Reference

Authors: Pearce SM, Daneshmand S. Journal: Urol Clin North Am. 2018 Feb;45(1):55-65. doi: 10.1016/j.ucl.2017.09.004. PMID: 29169451