Our Summary

This research paper is about a procedure called urinary diversion which is performed by Gynecologic Oncologists. This operation was more common in the past but has become less so due to better prevention of cervical cancer. The paper’s purpose is to give a detailed review of the procedure for these specialists.

The paper emphasizes that surgeons who perform this complicated procedure need to understand the differences between various types of urinary diversions, and how to care for patients before and after the operation. This includes knowing when the surgery is necessary, considering factors before the operation, understanding the different types of urinary diversions, and the importance of regularly checking up on patients who have undergone the procedure. This is because these patients will need lifelong monitoring of their upper urinary tracts and nutritional and metabolic changes.

In simpler terms, this is a guide for doctors on how to perform a specific type of operation that reroutes urine flow, when it’s needed, how to prepare for it, and how to take care of patients after the procedure.

FAQs

  1. What is the purpose of urinary diversion surgery and who typically performs it?
  2. What are the differences between continent and non-continent urinary diversions?
  3. What is involved in the pre and post-operative care for urinary diversion surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urinary diversion surgery is to make sure to follow all post-operative care instructions carefully. This may include instructions on how to care for the surgical site, managing pain, and maintaining proper nutrition and hydration. It is important to attend all follow-up appointments and screenings to monitor for any complications and ensure the long-term success of the surgery.

Suitable For

Patients who are typically recommended urinary diversion surgery include those with:

  1. Bladder cancer: Patients with invasive bladder cancer may require urinary diversion surgery if their bladder needs to be removed (cystectomy).

  2. Neurogenic bladder: Patients with neurological conditions such as spinal cord injury, multiple sclerosis, or spina bifida may have difficulty emptying their bladder properly and may require urinary diversion surgery.

  3. Radiation cystitis: Patients who have undergone pelvic radiation therapy for conditions such as cervical or prostate cancer may develop radiation-induced damage to the bladder, requiring urinary diversion surgery.

  4. Congenital anomalies: Patients born with abnormalities of the urinary tract, such as bladder exstrophy or posterior urethral valves, may require urinary diversion surgery.

  5. Chronic urinary retention: Patients with chronic urinary retention that cannot be managed conservatively may require urinary diversion surgery to allow for proper drainage of urine.

  6. Interstitial cystitis: Patients with severe interstitial cystitis that is unresponsive to conservative treatment may benefit from urinary diversion surgery.

  7. Recurrent urinary tract infections: Patients with recurrent urinary tract infections that are not responsive to medical management may require urinary diversion surgery to prevent further infections.

  8. Severe urinary incontinence: Patients with severe urinary incontinence that is not responsive to conservative treatment may benefit from urinary diversion surgery to improve their quality of life.

Timeline

Before urinary diversion surgery:

  • Patient is diagnosed with a condition such as bladder cancer, neurogenic bladder, or other urinary tract disorders that require surgical intervention.
  • Patient undergoes pre-operative evaluations, including imaging studies, blood tests, and consultations with various specialists.
  • Patient receives counseling on the different types of urinary diversion options available and makes a decision with their healthcare team on the best option for their individual situation.

After urinary diversion surgery:

  • Patient undergoes a period of recovery in the hospital, typically lasting several days to a week depending on the type of surgery performed.
  • Patient receives education on how to care for their urinary diversion, including managing catheters, stoma care, and potential complications to watch for.
  • Patient may require ongoing follow-up care, including regular check-ups with their healthcare team, imaging studies to monitor for complications, and adjustments to their care plan as needed.
  • Patient may need to make lifestyle modifications, such as dietary changes or modifications to their daily activities, to accommodate their urinary diversion.
  • Patient may experience improvements in their quality of life, such as relief from urinary symptoms or improved control over their bladder function.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with urinary diversion surgery?
  2. What type of urinary diversion surgery is recommended for my specific condition?
  3. How will the surgery impact my daily life, including activities, diet, and hygiene?
  4. What is the expected recovery time and post-operative care plan?
  5. Will I need additional treatments or follow-up care after the surgery?
  6. How will the surgery affect my urinary function and quality of life?
  7. What are the long-term implications and potential complications of urinary diversion surgery?
  8. Are there alternative treatment options available for my condition?
  9. How experienced is the surgical team in performing urinary diversion surgeries?
  10. Can you provide me with information or resources for support groups or counseling for patients undergoing urinary diversion surgery?

Reference

Authors: Johnson OK, Berchuck A, Secord AA, Peterson AC. Journal: Gynecol Oncol. 2018 Feb;148(2):414-421. doi: 10.1016/j.ygyno.2017.10.021. Epub 2017 Nov 28. PMID: 29191437