SURGEON'S WORKSHOP
SIMPLIFIED M E T H O D FOR OUTPATIENT TEACHING OF CONTINENT RESERVOIR CATHETERIZATION A R T H U R I. SAGALOWSKY, M.D. F r o m the Division of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
have been performing continent upravesieal urinary diversion in ates. To date, over 60 eases have ] with an abdominal stoma. The es have been some form of detucolon reservoir--either patched ,lded right colon. An intussus• ileal nipple across the ileoeeeal ; continence. Initially a single (either 30F Medena tube or 28F through the stoma was placed at trgery and was maintained for ?ostoperatively. Patients w e r e a one-night hospitalizaton to be ttermittent catheterization of the 7¢e have modified the aformenue and m a n a g e m e n t to include a seeondary reservoir eatheter laleeot located inferior to the limb and nipple valve (Fig. 1). rs three i m p o r t a n t advantages. ~nee of two catheters minimizes mucous plugging. Seeond, the ving as short and straight an elpossible for ease of eatheterizaognized. In our experience w h e n had trouble eatheterizing, the has been that the catheter false [y and the true passage through ze is angulated superiorly. Plaeedeeot eatheter and anchoring the ~speet of the reservoir to the abcreates a base-plate of sorts and ; p r o b l e m with eatheterization. esenee of a secondary eatheter need for hospitalizing the patient ;truetion. At the three-week post~e visit the stomal eatheter is realeeot catheter is d a m p e d , and h o w n h o w to eatheterize the res_ ~ atient has any trouble eatheteriz-
FIGURE 1. A 28F Foley catheter is placed through stoma and secondary 22F Maleeot catheter exits from inferior aspect of reservoir. ing at home, he m a y simply open the Malecot catheter to drainage. This is most reassuring to the patient as well as cost-effective. The patient returns after three to seven days; of intermittent catheterization, w h e n he is eonfident with the technique, and the Ma]Leeot catheter is removed. The Maleeot catheter site heals most quickly, a n d the p a t i e n t is not troubled with leakage if a stomal eatheter is left indwelling for two to three days at this time. Attention to these details of stomal eonstruetion and care help patients to realize the maximal benefits of eontinent urinary diversion. 5323 Harry Hines Boulevard Dallas, Texas 75235-9031
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FEBRUARY 1991
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V O L U M E XXXVII, N U M B E R 2
167
SIMPLIFIED M E T H O D FOR OUTPATIENT TEACHING OF CONTINENT RESERVOIR CATHETERIZATION A R T H U R I. SAGALOWSKY, M.D. F r o m the Division of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
have been performing continent upravesieal urinary diversion in ates. To date, over 60 eases have ] with an abdominal stoma. The es have been some form of detucolon reservoir--either patched ,lded right colon. An intussus• ileal nipple across the ileoeeeal ; continence. Initially a single (either 30F Medena tube or 28F through the stoma was placed at trgery and was maintained for ?ostoperatively. Patients w e r e a one-night hospitalizaton to be ttermittent catheterization of the 7¢e have modified the aformenue and m a n a g e m e n t to include a seeondary reservoir eatheter laleeot located inferior to the limb and nipple valve (Fig. 1). rs three i m p o r t a n t advantages. ~nee of two catheters minimizes mucous plugging. Seeond, the ving as short and straight an elpossible for ease of eatheterizaognized. In our experience w h e n had trouble eatheterizing, the has been that the catheter false [y and the true passage through ze is angulated superiorly. Plaeedeeot eatheter and anchoring the ~speet of the reservoir to the abcreates a base-plate of sorts and ; p r o b l e m with eatheterization. esenee of a secondary eatheter need for hospitalizing the patient ;truetion. At the three-week post~e visit the stomal eatheter is realeeot catheter is d a m p e d , and h o w n h o w to eatheterize the res_ ~ atient has any trouble eatheteriz-
FIGURE 1. A 28F Foley catheter is placed through stoma and secondary 22F Maleeot catheter exits from inferior aspect of reservoir. ing at home, he m a y simply open the Malecot catheter to drainage. This is most reassuring to the patient as well as cost-effective. The patient returns after three to seven days; of intermittent catheterization, w h e n he is eonfident with the technique, and the Ma]Leeot catheter is removed. The Maleeot catheter site heals most quickly, a n d the p a t i e n t is not troubled with leakage if a stomal eatheter is left indwelling for two to three days at this time. Attention to these details of stomal eonstruetion and care help patients to realize the maximal benefits of eontinent urinary diversion. 5323 Harry Hines Boulevard Dallas, Texas 75235-9031
!;
/
FEBRUARY 1991
/
V O L U M E XXXVII, N U M B E R 2
167
