a. Diversion of urine out of the body through an opening in the
abdominal wall bypassing the bladder, which requires a
pouch to be worn outside the body; or, a continent diversion
involving the creation of a pouch or bladder inside the body,
usually using part of the digestive tract
i. Incontinent urinary diversions
1. Ileal conduit
2. Colonic conduit
ii. Continent urinary diversions
1. Catheterizable urinary reservoir: Kock reservoir or
Indiana (ileocecal) pouch
2. Orthotopic continent urinary diversion: neobladder
II. Etiology (Costa & Kreder, 2006)
a. Bladder cancer, primary or metastatic, requiring
cystectomy—fourth most common cancer in the
b. Neurogenic bladder, such as may occur following spinal
c. Severe radiation injury to the bladder
d. Intractable incontinence
e. Chronic pelvic pain syndromes
a. Morbidity: In 2008, an estimated 68,810 new cases of
bladder cancer were reported in the United States; male-tofemale
ratio is 2.6:1; in 2005, median age at diagnosis was
age 73 (National Cancer Institute [NCI], 2008).
b. Mortality: Rate is reportedly 1% to 3% for radical cystectomy,
often associated with advanced age and comorbidities
(Lohr & Sherk, 2004).
Client is treated in acute surgical unit.
Psychosocial aspects of care,
1. Prevent complications.
2. Assist client and significant other (SO) in physical and
3. Support independence in self-care.
4. Provide information about procedure, prognosis, treatment
needs, potential complications, and resources.
1. Complications prevented or minimized.
2. Adjusting to perceived or actual changes.
3. Self-care needs met by self or with assistance, as necessary.
4. Procedure, prognosis, therapeutic regimen, and potential
complications understood and sources of support identified.
5. Plan in place to meet needs after discharge.