Urostomy

Abstract: The psychosocial adjustment and general state of health were investigated in 66 patients (40 males, 26 females) who had been subjected to an ileal conduit urinary diversion on account of bladder cancer (44 patients) or incontinence or bladder dysfunction (22 patients). Seventy per cent of the patients reported unchanged, overall, social activity (OSA) after the operation. Twenty per cent reported less and 10% more activity. Bladder-cancer patients were more likely to curtail their social activities compared with the patients with incontinence or bladder dysfunction. Appliance-related problems were mentioned by half of the patients who reported decreased OSA. One-third of the patients considered accidental leakage or fear of such leakage as the most negative aspect of surgery. Factors related to an altered body image were the most common negative aspect reported by females. Despite psychosocial problems, the majority of the patients (80%) considered their health to be good. Males, individuals worki...

Abstract: Purpose The purpose of this study was to examine stoma and peristomal complications and related variables among adults with ostomies. The primary study aim was to determine the incidence of peristomal and stoma complications during the first 3 months after stoma creation. Design Data were collected using a prospective, repeated-measures descriptive study design. Subjects and setting Data were collected at 2 university-based hospitals with outpatient ostomy clinics in the Midwestern United States. The sample included 43 adults with newly created colostomy, ileostomy, or urostomy stomas. Methods Participants were examined for the presence of complications up to 4 times during a 3-month period: within 7 days of surgery. Patients were also evaluated at 2, 6, and 12 weeks after stoma creation. Data were collected using a validated instrument with acceptable interrater reliability. Results Peristomal skin complications developed in 27 participants, comprising 63% of the sample. The onset of peristomal skin complications occurred most frequently during the 21- to 40-day time period. The most common skin conditions at nearly all time intervals were irritation (peristomal moisture-associated skin damage) and infection. Of the 18 participants observed 70 days or longer, just 7 (38%) remained free of peristomal skin complications throughout the study. Six participants developed 1 or more stoma complications, all of which occurred 20 or more days after surgery. No demographic or clinical factors were found to be associated with the development of complications. Conclusions Although the participants were evaluated at regular intervals by a specialized nurse, the majority experienced peristomal skin complications. These results underscore the importance of further work in interventions to prevent and treat peristomal skin complications and to provide ongoing outpatient follow-up to individuals with stomas.

Abstract: BACKGROUND AND AIMS: This study was aimed to evaluate the late complications of ostomy surgery in a strictly followed patient population of a university hospital. MATERIAL AND METHODS: An actuarial analysis of the complications of 156 patients with permanent ostomies using the life-table method was performed. RESULTS: The crude and actuarial risks of late stomal complications in 156 patients after a mean follow-up of 8 years were 39 per cent and 59 per cent. The cumulative risk of complications did not differ between the stoma types. Paracolostomy hernia was the most common complication of the colostomy, 27 per cent, retraction of ileostomy, 24 per cent, and intestinal obstruction of urostomy, 28 per cent. Mesenteric fixation was here associated with a lower chance of prolapse (P < 0.025), but the closure of lateral space did not reduce the risk of intestinal obstruction. Skin irritation was more common after a creation of ileostomy than after other stoma creations (P < 0.001). The revisional surgery rate was lower following colostomy than following other stoma formations (P < 0.034). Adaptation to the stoma had occurred in 74% of the patients, but 8 per cent of the patients had intractable symptoms at the time of the analysis. CONCLUSION: Ostomy surgery involves a high rate of late complications and there is a small but important subgroup of patients whose quality of life is seriously affected.

Abstract: Summary— A group of 66 patients (40 males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bladder dysfunction (22). They were questioned about pre-and post-operative sexual function and activity and it was found that 90% of the males (26/29) who were sexually active before surgery lost the ability to achieve erection following radical cystectomy. Although they were unable to achieve penile erection, 41% were able to experience orgasm by means of masturbation. Five of the 29 males received penile implants. Five of the 6 females treated by cystectomy, who were sexually active before the operation, reported either a decrease or cessation of sexual activity (i.e. coitus) post-operatively. The main problems were a decrease in sexual desire, dyspareunia and vaginal dryness. One women reported the inability to experience orgasm after surgery. Compared with women with bladder cancer, those with incontinence/bladder dysfunction were more likely to have an active sexual life after urostomy surgery. Seven females in this group, of whom 4 were sexually inactive before surgery, increased their sexual activity after the operation. For these women the conduit operation removed the need to use incontinence pads or indwelling catheters.