Clean Intermittent Catheterization after Sigmoid Augmentation Cystoplasty and Abdominal Sigmoidostomy: A Case Report / 中国康复理论与实践

Objective:To summarize the nursing care of a patient with clean intermittent catheterization after sigmoid augmentation cystoplasty and abdominal sigmoidostomy for the treatment of neurogenic bladder. Methods:On October 16, 2017, one patient with neurogenic bladder was admitted to Beijing Bo'ai Hospital. Psychological instructions were given to the patient after surgery. Catheter of appropriate type and material was selected, and then the patient was instructed to implement correct and regular clean intermittent catheterization procedures. At the same time, nursing care of abdominal sigmoidostomy was carried out. In order to prevent tube blocking, bladder irrigation was implemented at regular intervals. Follow-up visit was scheduled. Results:After four-month follow-up, the patient completed the whole procedures successfully, and its renal function was protected without severe urinary tract infection, also the patient was with good social adaptation. Conclusion:Comprehensive nursing care is needed in patients after sigmoid augmentation cystoplasty and abdominal sigmoidostomy. Correct and regular clean intermittent catheterization is critical. Psychological nursing, care of abdominal sigmoidostomy and tube blocking prevention should not be neglected, also long-term follow-up is of great significance for the outcome.

The Antegrade Continence Enema Procedure Using Retubulized Sigmoidostomy

PURPOSE: A Malone appendicostomy and a Monti ileostomy are effective surgical modalities for treating children with congenital intestinal dysfunction or fecal incontinence. However, a left colonic antegrade continence enema (ACE) has been reported as an alternative. This paper evaluated the efficiency of ACE, using a retubulized sigmoidostomy (RS), for maintaining fecal continence, and its acceptability as a first line surgical treatment. METHODS: 11 patients underwent surgery between March 2002 and July 2003: 8 meningomyelocele, 1 cloacal anomaly, 1 anorectal malformation and 1 lipoma of the spine. An RS tube was fashioned, and then implanted using a segment of the sigmoid colon, and exteriorized through the umbilicus. An enema was begun 12 days after surgery using only normal saline. The outcome were assessed after adjusting the appropriate enema regimen for the 11 cases. RESULTS: The mean duration of the enema was 22.0+/-8.4 minutes, with 250 ml (80~800 ml) as the median volume of fluid used. The enema interval ranged from 1 to 3 days. No patient showed any abdominal discomfort or soiling episodes, with the exception of one that experienced day-time fecal staining, but this occurred less than once per month. The self-cosmesis for the umbilical stoma was satisfactory. CONCLUSION: The RS procedure provided excellent continence control, with a shortening of the duration of the enema, a lower fluid volume and good cosmesis, without any ACE related abdominal pain. This procedure can be used as the first choice surgical treatment for intractable constipation and fecal incontinence.

A Case of Ureteroileocecal Sigmoidostomy with Sigmoid J Pouch / 대한비뇨기과학회지

We performed a case of ureteroileocecal sigmoidostomy in a 56-year-old female patient who had transitional cell carcinoma of the bladder(pT3aNoMo, grade III, mutiple, papillary). Both ureters were anastomosed to the ileal end of the ileocecal segment and colonic end was anastomosed to the J pouch of the sigmoid colon. At 7 months postoperatively, the intraluminal pressure of the pouch is 20 cmH2O in supine position, 40 cmH2O in sitting or squatting position, 90-100 cmH2O on voiding. No visible reflux of fecal and urinary stream into upper urinary tract was observed on both antegrade and retrograde pouchgraphy. No ectatic changes of upper urinary tract was seen on excretory urography until 36 months postoperatively. There was no changes in CBC, liver function, renal function and serum electrolytes. Even though there had been no febrile attack without any antibiotic medications during follow-up period, bilateral renal scarring was observed on CT films of postoperative 24 months. Continuous suppressive dose of sulfamethoxazole- trimethoprim was started. She passes urine in diarrhea pattern every three to four hours and has no leakage in night time. She satisfies with status of voiding at present after 30 months postoperatively. No visible reflux into upper urinary tract from the pouch is identified, ascending infection could not be prevented by this antireflux method only. This procedure can be an alternative way of urinary diversion in the era of bladder substitution if ascending infection can be prevented by enforced and more secure procedures to prevent reflux are added.

Experiences in Ureteroileocecal Sigmoidostomy / 대한비뇨기과학회지

Ureteroileocecal sigmoidostomy is a method of continent urinary diversion which can protect the upper urinary tact from urinary reflux and infection, without external collecting devices and concomitant catheterization as in other forms of urinary diversion. Recently, we experienced 7 cases of ureteroileocecal sigmoidostomy in bladder cancer. Of them, 3 cases of immediate complications (retroperitoneal urinoma, wound disruption and ureteral obstruction ) were developed, but they could be corrected with prolonged placement of rectal tube or corrective surgery. And then, ureteral reflux, upper urinary tract infection and incontinence were not observed. So, ureteroileocecal sigmoidostomy is an attractive method of continent urinary diversion in selected cases.

Experiences in Ureteroileocecal Sigmoidostomy / 대한비뇨기과학회지

Ureteroileocecal sigmoidostomy is a method of continent urinary diversion which can protect the upper urinary tact from urinary reflux and infection, without external collecting devices and concomitant catheterization as in other forms of urinary diversion. Recently, we experienced 7 cases of ureteroileocecal sigmoidostomy in bladder cancer. Of them, 3 cases of immediate complications (retroperitoneal urinoma, wound disruption and ureteral obstruction ) were developed, but they could be corrected with prolonged placement of rectal tube or corrective surgery. And then, ureteral reflux, upper urinary tract infection and incontinence were not observed. So, ureteroileocecal sigmoidostomy is an attractive method of continent urinary diversion in selected cases.