Continent urinary diversion and the ileal cecal pouch with appendostomy: a review with nursing care

Creation of a continent urinary reservoir has become the procedure of choice when the bladder is removed for either malignant or nonmalignant disease. The continent urinary reservoir provides the patient with a manageable and socially acceptable bladder replacement. It is important for the ET nurse to have a basic understanding of the surgical principles of continent urinary diversion, including the antireflux and continence mechanism, and segment of bowel used. Such an understanding facilitates competent patient care and appropriate instruction, both before and after operation. The basic principles of continent urinary diversion are discussed in this article, along with a brief description of the most common continent urinary reservoirs. In addition, a recent form of urinary diversion, the ileocecal pouch with appendostomy, is described, and relevant preoperative and postoperative care is outlined.