Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings / Trinta anos do serviço de atenção à saúde da pessoa ostomizada de Juiz de Fora e região

ABSTRACT Objective: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. Method: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. Results: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). Conclusions: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.

RESUMO Objetivo: elaborar o perfil epidemiológico dos pacientes estomizados atendidos no Serviço de Atenção à Saúde da Pessoa Ostomizada de Juiz de Fora e região (SASPO/JF) e quantificar tanto as patologias que levaram à confecção, quanto as complicações presentes nas estomias. Método: realizado estudo retrospectivo com análise de 496 prontuários de pacientes cadastrados no SASPO/JF ao longo de 30 anos e que permaneciam em atendimento no serviço em junho de 2018. Foram consideradas as seguintes variáveis: idade, sexo, patologia que levou à confecção do estoma, tipo, caráter temporal, localização e complicações das estomias. Resultados: 53,43% dos pacientes eram do sexo masculino e 46,57% do sexo feminino. A média de idade entre os homens foi de 56,24 anos e entre as mulheres foi de 58,40 anos. Oito pacientes apresentaram dois tipos de estomias simultaneamente e o total de 504 estomias foi distribuído da seguinte forma: 340 colostomias (67,46%), 117 ileostomias (23,21%) e 47 urostomias (9,33%). Além disso, 47,65% das colostomias e 76,92% das ileostomias foram temporárias, enquanto todas as urostomias foram permanentes. Em 70,24% dos casos, o motivo para confecção do estoma foi a neoplasia maligna. Foram encontrados 277 estomas com uma ou mais complicações (54,96%). Conclusão: as estomias predominaram em pacientes com mais de 50 anos e o principal diagnóstico que levou à confecção dos estomas foi a neoplasia maligna. As ileostomias apresentaram maior percentual de complicações do que as colostomias e urostomias e, para todos os tipos de estomas, a complicação mais frequente foi a dermatite.

Caso Clínico: Abordaje de Ostomias / Case Report: Advertisement of Ostomias

INTRODUCCION: Las ostomías tienen diferente localización según el procedimiento quirúrgico. En este caso la colostomía es intervención quirúrgica para comunicar el intestino grueso con la pared abdominal. La ileostomía comunica al intestino delgado hacia la pared abdominal, están indicadas en diversos procedimientos y situaciones patológicas del intestino. CASO CLINICO: Paciente masculino de 70 años de edad, presento alza térmica, astenia, dolor abdominal y pélvico, melenas, ruidos hidroaéreos disminuidos, depresible, doloroso a la palpación, timpánico a la percusión, con bolsa de colostomía en flanco izquierdo y de ileostomía en hipocondrio derecho, fístula colocutánea en zona suprapúbica de aproximadamente 2 cm de diámetro, extremidades de tono y fuerza muscular disminuida, marcha inestable, deambula con ayuda. Antecedentes patológicos: hipertensión arterial, trastorno depresivo y esquizofrenia, vólvulo intestinal y deshidratación. EVOLUCIÓN: Paciente con antecedente de vólvulo, se realiza laparotomía exploratoria, sigmoidectomía, lavado de cavidad abdominal y colostomía. Un año después, se realiza cierre de colostomía, adherenciolisis, apendicectomía, resección intestinal con anastomosis latero lateral ileocecal, reconstrucción del tránsito mediante anastomosis colorectal termino-terminal; luego de dos meses reingresa por dehiscencia de anastomosis colorectal, se realiza colostomía e ileostomía de descarga, es hospitalizado por un mes; reingresa dos semanas después con evidencia de fístula colocutánea, dado de alta luego de 31 días de hospitalización, con cierre espontáneo de fístula y en regular estado general es trasladado a asilo de ancianos. CONCLUSIÓN: Se trata de un caso de colostomía más ileostomía y fístula abdominal, paciente con complicaciones y reingresos frecuentes. El abordaje de enfermería en el manejo de ostomías es fortalecer los cuidados y conseguir en el paciente el autocuidado y la reinserción a su vida cotidiana.(AU)

BACKGROUND: The colostomy is a surgical procedure to communicate the large intestine with the abdominal wall. The ileostomy communicates to the small intestine towards the abdominal wall; they are indicated in diverse procedures and pathological situations of the intestine. CASE REPORT: A 70-year-old male patient with fever, asthenia, abdominal and pelvic pain, melena, decreased bowel sounds, painful palpation, tympanic noise at percussion, left flank colostomy and ileostomy in right hypochondrium, colocutaneous a fistula in suprapubic area of approximately 2 cm diameter, limbs of tone and decrease muscle strength, unsteady gait, wandering with help, depressive. Pathological antecedents: arterial hypertension, depressive disorder and schizophrenia, intestinal volvulus and dehydration. EVOLUTION: Patient with history of volvulus, exploratory laparotomy, sigmoidectomy, lavage of the abdominal cavity and colostomy. One year later the colostomy was closed, adherenciolysis, appendectomy, intestinal resection with lateral ileocecal lateral anastomosis and reconstruction of the transit through a termo-termino colorectal anastomosis; After two months of re-entry due to dehiscence of colorectal anastomosis, colostomy and ileostomy discharge, he was hospitalized for a month; The re-entry two weeks later with evidence of postoperative fistula, discharged after 31 days of hospitalization, with spontaneous closure of the fistula and in general regular state is transferred to the nursing home. CONCLUSION: It is a case of colostomy plus ileostomy and abdominal fistula in patient with frequent complications and re-entries. The approach of nursing in the management of ostomies is to strengthen the care, to obtain and teach in the patient the self-care and the reintegration into their daily life. (AU)

Qualidade de vida de pessoas com estomias intestinais de eliminação / Quality of life of people with intestinal stomas

Resumo Objetivos Objetivou-se avaliar a qualidade de vida de pessoas com estomias intestinais de eliminação e verificar sua associação com características sociodemográficas e clínicas. Métodos Trata-se de estudo descritivo e transversal realizado com 96 pessoas cadastradas em um Programa de estomizados, utilizando o City of Hope - Quality of Life- Ostomy Questionnary. Resultados O escore médio de QV total deste estudo foi 6,2 ± 2,8. O maior escore médio foi encontrado no domínio Bem-estar espiritual 7,5 (±1,9) e o menor no domínio Bem-estar social 5,6 (±2,1). As características sociodemográficas (renda per capita, escolaridade, religião) e as características clínicas (permanência e adaptação à estomia, tempo de estomizado para sentir-se confortável, dificuldade para o autocuidado e limitação para realização de atividades diárias) associaram-se a qualidade de vida total e seus domínios (p <0,05). Conclusão As estomias intestinais de eliminação interferem na qualidade de vida, principalmente nos âmbitos físico e social.

Abstract Objectives To evaluate the quality of life of people with intestinal stomas and verify its association with sociodemographic and clinical characteristics. Methods A cross-sectional descriptive study was carried out with 96 people registered in an ostomy program, with the use of the City of Hope-Quality of Life-Ostomy Questionnaire. Results The mean score of total QoL in this study was 6.2± 2.8. The highest mean score was found in the spiritual well-being dimension 7.5 (±1.9) and the lowest in the social well-being dimension 5.6 (±2.1). Sociodemographic characteristics (per capita income, education level, religion) and clinical characteristics (length of use and adaptation to the stoma, length of time needed for ostomized people to feel comfortable, difficulty with self-care, and limitation to perform activities of daily living) were associated with total quality of life and its dimensions (p <0.05). Conclusion Intestinal stomas interfere with quality of life, especially in physical and social dimensions.

Perineostomy: the last oportunity

Objective To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. Material and methods We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. Results The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35%, idiopathic etiology in 29% and prior hypospadia repair in 18%. Postoperative failure occurred in 3 patients, with a final success of 82.4%. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). Conclusions The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis. .

Técnica de Yang-Monti en ostomías continentes para cateterismo intermitente: experiencia de 15 años en Hospital Carlos Van Buren / Yang-­Monti technique in continent ostomies for intermittent catheterization: experience of 15 years in Hospital Carlos Van Buren

Introducción: Existen situaciones en la práctica urológica, en que el daño al aparato esfinteriano, uretra o vejiga obliga a recurrir a algún mecanismo que permita derivar un reservorio o vejiga ampliada hacia la pared abdominal. Para ello, es posible realizar ostomías continentes, con distintos segmentos intestinales, para autocateterismo intermitente limpio. La técnica de Yang-Monti presenta ventajas con respecto a otras ostomías, como el uso de un segmento intestinal pequeño, la mayor facilidad en ubicar y fijar la ostomía. Objetivo: Describir la experiencia de la técnica de Yang-Monti para cateterismo intermitente limpio, su evolución a través del tiempo y sus principales complicaciones según la casuística de nuestro centro. Materiales y Método: Estudio observacional retrospetivo. Revisión de 31 casos de ostomías continentes para cateterismo intermitente con la técnica de Yang-Monti desde enero de 1996 a septiembre del 2011. Se evalúa el diagnóstico etiológico, segmento intestinal del reservorio, ubicación del extremo distal de la ostomía y sus respectivas complicaciones precoces, tardías y estado al final del seguimiento. Resultado: En relación al segmento intestinal utilizado para reservorio, en 14 casos (45 por ciento) se utilizó colon sigmoides, en 9 (29 por ciento) íleon y en 8 transverso (26 por ciento). Con respecto al lugar en que fue exteriorizado el conducto de Yang-monti, en 19 casos (61por ciento) fue al ombligo y en 12 (39 por ciento) a fosa iliaca. Hubo complicaciones precoces (antes de 3 meses) en 8 pacientes (25 por ciento), de los cuales 4 (12,9 por ciento) requirieron reintervención, 3 de estos fallecen precozmente a consecuencia de la cirugía, presentando los diagnósticos de evisceración, obstrucción intestinal e infección de herida operatoria...

Introduction: There are situations in urological practice, in that the damage to the sphincter apparatus, urethra or bladder makes it necessary to use some mechanism to derive an enlarged reservoir or bladder to the abdominal wall. It is therefore possible to use different intestinal segments as continente ostomies for intermittent self cathetherisation. Yang Monti technique presents advantages over other ostomies: use of a small intestinal segment, easier placement and fixation. Objective: To describe the experience of the Yang-­‐Monti technique for clean intermittent catheterization, its evolution over time and its major complications in our center. Materials and Methods: Observational retrospective study. Review of 31 cases of Yang‐Monti intermittent catheterization continente ostomies from January 1996 to September 2011. Etiologic diagnosis, intestinal segment of the reservoir, location of the distal end of the ostomy and their early and late complications, and follow-­‐up status are evaluated. Results: Regarding the intestinal segment used for reservoir: in 14 cases (45 percent) was used sigmoid colon, in 9 ileum (29 percent) and in 8 transverse colon (26 percent). The Yang‐Monti was externalized in the navel in 19 cases (61 percent) and in iliac fossa 12 (39 percent)...

Ostomías continentes para cateterismo intermitente: experiencia del Hospital Carlos van Buren / Continent stomas for intermittent catheterization: Hospital Carlos van Buren’s experience

Introducción: Existen situaciones en la práctica urológica, en que el daño al aparato esfinteriano, uretra o vejiga obliga a recurrir a algún mecanismo que permita derivar un reservorio o vejiga ampliada hacia la pared abdominal. Para estos fines es posible realizar ostomías continentes, con distintos segmentos intestinales, para autocateterismo intermitente limpio. Objetivo: Describir la experiencia con distintas técnicas de ostomía continente para cateterismo intermitente limpio, su evolución a través del tiempo y sus principales complicaciones según la casuística del Servicio de Urología del Hospital Carlos Van Buren. Materiales y Método: Estudio observacional retrospectivo. Revisión de 77 casos en los cuales se realizan ostomías continentes para cateterismo intermitente desde julio de 1988 a junio de 2009. Se evalúan: diagnóstico etiológico, técnica de ostomía, segmento intestinal, ubicación de extremo distal de ostomía y sus respectivas complicaciones precoces, tardías y estado al final del seguimiento. Resultado: En 83 ocasiones hemos necesitado hacer alguna derivación urinaria vesical continente a la pared abdominal con uso de segmentos intestinales. En 26 casos (31,3 por ciento) utilizamos íleon aplicado más alguna variedad que le permita cierta fijación. En nuestros últimos 33 (39,7 por ciento) pacientes hemos realizado la técnica de Yang-Monti, para ello se utilizó segmentos de intestino grueso en 27 casos (81,82 por ciento). La mayor cantidad de complicaciones de resolución quirúrgica (38,6 por ciento del total), se presentan en el periodo de 3 meses a 5 años; a su vez las complicaciones más graves lo hacen en el postoperatorio inmediato, en pacientes con baja reserva funcional (6 de 77) con 4 muertes en nuestra serie. La continencia es cercana al 100 por ciento, con 19,48 por ciento de reintervenciones de la ostomía para lograr este resultado. Conclusiones: El uso de ostomías continentes permite alcanzar un alto porcentaje de continencia

Introduction: There are situations in urologic practice, in which the damage to the sphincter, urethra or bladder forces to build some mechanism that allows diverting urine through a reservoir or augmented bladder towards the abdominal wall. For these purposes it is possible to build continent stomas, with different intestinal segments, for clean intermittent catheterization. Objective: To describe the Hospital Carlos van Buren’s experience with different continent stoma techniques for clean intermittent catheterization, its evolution through time and its main complications. Materials and Method: Retrospective observational study. From July 1988 to June 2009, 77 cases in which continent stomas for intermittent catheterization were built. Etiologic diagnosis, surgical technique, intestinal segment, location of distal end of the stoma and its respective early and delayed complications and status at the end of follow-up are evaluated. Results: In 83 occasions we have needed to make some continent urinary diversion to the abdominal wall with use of intestinal segments. In 26 cases (31.3 percent) we used folded ileum plus some variety of fixations. In our last 33 (39.7 percent) patients we have used the Yang-Monti technique, and for that we used thick bowel in 27 cases (81.82 percent).Most complications of surgical resolution (38.6 percent of the total), appeared in the 3 months to 5 years period; most serious complications appeared in the early post-operative period, in patients with low functional reserve (6 of 77) with four deaths in the series. Continence is almost 100 percent, with 19.48 percent of stomal re-interventions to obtain these results. Conclusions: The use of continent stomas allows a high percentage of continence. This allows self standing patients, with a positive impact on their quality of life when compared to incontinent stomas