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    DR. MAS Urostomy in Malignancies Urology

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    DR. MAS Urostomy in Malignancies Urology

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    DR. MAS Urostomy In Malignancies Urology

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    DR. MAS Urostomy in Malignancies Urology

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    Jawa Tengah

    Urostomy In Malignancies Urology


    STOMA CARE

    ORCID ID 0000-0002-9425-003X
    dokter MAS
    2022
    urostomy
    Napoleon Bonaparte
    • Surgical procedure that creates a
    stoma (artificial opening) for the
    urinary system.
    • To avail for urinary diversion
    • In cases where drainage of urine
    through the bladder and urethra
    is NOT POSSIBLE, e.g. after
    extensive surgery or in case of
    obstruction.
    The ileal conduit
    • first described by Zaayer in
    1911due to vesicovaginal fistula
    and bladder cancer
    • Eugene M Bricker perform pelvic
    exenterations in advanced post-
    irradiation carcinoma of the
    cervix; established as a standard
    technique by in 1950
    • Pouch: Koch, Hauttman

    D.T. Basic etal, Institute of Urology and Nephrology, Clinical Center of Serbia. The history of urinary diversion.
    ACI VOL LIV, UDK 616.6-006.04-089.843(091)
    CUTANEOUS URETEROSTOMY
    • In 1856, Gigon considered ureterotomy to have
    the same effect as colostomy on the bowel.
    • In 1889, 1st unilateral cutaneous ureterostomy
    was carried out by Le Dentu, , due to obstructive
    anuria caused pelvic malignancy.
    • In 1925, Papin reported a series of 100 total
    cystectomies with cutaneous ureterostomy or
    nephrostomy following by lethality rate of 28.7%
    and 81 cystectomies with ureterosigmoidostomy
    following by lethality rate of 59.2%.
    • The morbidity and lethality following skin
    implantations were caused by poor methods of
    anastomosis which had led to obstruction and
    infection.
    1920 Koenig Rutzen
    constructed the prototype of a rubber bag

    modification stoma site two pieces

    D.T. Basic, The history of urinary diversion.


    Priyank Yadav T, A modified cutaneous ureterostomy provides satisfactory short and midterm outcomes in select cases
    STOMA CARE :
    irritated and red skin
    leaking seal urostomy bag, urine
    irritates the skin
    • urostomy opening is too big than
    stoma
    dry skin
    moist skin
    hair create gaps
    • the skin around the stoma is
    uneven, wrinkled
    mild pressure gauze
    • a spot of blood is a sign that the
    stoma is viable, pressing for a
    few minutes usually stops
    • clean exudate, serum
    • besides cleaning the ileum
    mucouse, urine so it doesn't
    irritate the skin also holds it so
    that the stoma glue can stick
    sign of infection

    REDNESS BEYOND 1/2 INCH AROUND STOMA PAIN, PUS,ITCHINESS,TINY RED BUMPS
    prolaps
    • reposition
    • if red and moist is not na
    medical emergency
    Urostomy complications
    • stomal retraction, stenosis or obstruction, herniation, prolapse, and
    peristomal skin irritation
    • asymptomatic parastomal hernias are the most common in obesity,
    advanced age, and malnutrition caused by fascial defects hernias are
    typically , may complain of abdominal discomfort, bulge, or bowel
    symptoms
    • Stomal stenosis may result from long-term ischemia, skin irritation
    from chronic cutaneous exposure to urine, stoma retraction, or fascial
    narrowing
    Rodrick Babakhanlou etal : Stoma-related complications and emergencies.Int J Emerg Med. 2022
    doi: 10.1186/s12245-022-00421-9
    retraction
    • is functioning below skin level
    unlikey disapears
    • can difficult to maintain good
    pouch seal
    • no output : from urostomy,
    leakage into body

    • Observe the possibility of stoma


    stenosis
    prevent stoma problem
    • 1945-1957: Different techniques by
    Hecke, Schinagel, Sewwel, Mc Donald and
    Heckel, have been designed to support an
    adequate nipple of ureter by skin flaps.
    • A novel modifications of the technique by
    implantation of ureters side by side and
    double ureterostomy, have been
    advocated by Eckstein and Chutte and
    Sallade (1963)
    • De Vries reported, in 1955, that 33% of
    American urologists prefer cutaneous
    ureterostomy than implantation into the
    bowel.
    Metabolic complications
    • the ileum is responsible for the absorption of vitamins, minerals, and bile salts,
    urinary diversion can be associated with serious metabolic complications,
    including electrolyte and metabolic disturbances, nutritional deficiencies,
    bone disorders, and urolithiasis
    • the ileum absorbs ammonium and chloride and excretes bicarbonate resulting
    in hyperchloremic metabolic acidosis in 70% of patients with intestinal urinary
    diversions
    • Clinically patients may present to the emergency department complaining of
    fatigue, lethargy, weakness, or weight loss
    • Treatment in the emergency department includes correction of the acidosis
    with sodium bicarbonate or sodium citrate and replacement of the electrolytes
    and hydration.
    Rodrick Babakhanlou etal : Stoma-related complications and emergencies.Int J Emerg Med. 2022
    doi: 10.1186/s12245-022-00421-9
    Bricker ileal conduit vs. Cutaneous ureterostomy
    Comparison : ureterocutaneostomy versus ilealconduit
    2004 - 2016 the Surveillance, Epidemiology, and End Results (SEER) database.

    Huang et al . BMC Geriatrics (2021) https://doi.org/10.1186/s12877-020-01861-9


    Quality of Life
    Ileal Orthotopic NeoBladder, Ileal Conduit, Cutaneus Ureterostomy

    continent urinary diversion and incontinent urinary diversion


    •QLQ-C30 higher in IONB group compared to the IC group at 3 months of follow up (p = 0.02).These differences
    were not significant at the 6-month follow-up
    •SF-36 A significant lower body pain (SF36) was found in the IONB group compared with the IC group: (p = 0.05)
    Arman Tsaturyan etal. Assessment of health-related quality of life of male patients with ileal orthotopic neobladder compared to cutaneous
    ureterostomy.Cent European J Urol. 2020 doi: 10.5173/ceju.2020.0028

    focusing on functional outcomes, sexual function, and health related QoL for female
    • EORTC-QLQ-C30 : physical functioning, global health status (IONB vs. CU) PF(66.5 vs. 57.9, p = 0.011) GS 58.1
    vs. 42.6, p <0.001) were superior in the IONB arm
    • FACT-Bl-Cys questionnaire : functional health (15.3 vs. 11.9, p <0.001) and total score (110.1 vs. 101.7, p =
    0.009) were superior in the IONB arm
    Salvatore Siracusano etal. Quality-of-Life Outcomes in Female Patients With Ileal Conduit or Orthotopic Neobladder Urinary Diversion: 6-Month Results
    of a Multicenter Prospective Study. Sec. Genitourinary Oncology, 12 April 2022. doi.org/10.3389/fonc.2022.855546
    Jawa Tengah

    TAKE HOME MESSAGE

    • Urostomy one of the standard urinary diversion procedures after


    bladder removal
    • Developments in surgical techniques and equipment have made
    urostomy accepted by the public
    • Stoma care can be used as a mitigation of complications so that
    problem solving can be done earlier and increasing quality of life

    dokter MAS 2022


    terima kasih

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