Search

Background. How to derive urine is stemmed from removal of the bladder and from the necessity of its disengaging from the process of urination. Most surgeons prefer to do incontinent urine derivation in elderly and senile patients.Subjects and methods. In 2007 to 2009, the Leningrad Regional Oncology Dispensary treated 103 patients with diseases requiring the bladder be removed. All these patients underwent cystectomy as an independent operation or one of the surgical stages, followed by incontinent urine derivation described by Bricker. The patients were divided into 2 groups: 1) Bricker-type end-to-side ureteroileal anastomosis; 2) Wallace-type one. Group 1 comprised 50 patients: 37 (74 %) women and 13 (26 %) men; Group 2 included 53 patients: 48 (90.6 %) women and 5 (9.6 %) men. These were elderly and senile patients aged 60 to 79 years (mean age 65 ± 3.71).Results. In Group 1, 36 (72 %) patients were preoperatively diagnosed as having hydroureteronephrosis (HUN). Of them, 23 (64%) patients underwent preoperative percutaneous puncture nephrostomy (PPN). In Group 2, HUN was diagnosed in 43 (81 %) patients; of them 27 (63 %) had PPN. Complications and resurgeries were more common in Group 1 (p < 0.001). In Group 2, there were a larger number of cases of incompetence of the ureteroileal anastomosis. This complication required no surgical correction, but a longer drainage standing.Conclusion. The Bricker operation is the safest urine derivation in elderly and senile patients after surgery involving cystectomy. Wallacetype ureteroileal anastomosis during the Bricker operation is accompanied by a considerable reduction in the number of early and late postoperative complications and resurgeries. Wallace-type ureteroileal anastomosis is considered the method of choice in cancer patients.

Total urinary resection results with the necessity of creation an urostomy for the diversion of urine. Bricker ileal conduit is one of the most common solution here. Preparing the patient for self-care and self-reliance is one of the most important elements of care provided for patients after total urinary resection. It also should be followed by full social integration of these patients. The objective of this study was to assess if patients who underwent Bricker ileal urinary diversion were well prepared for self-care. The study group comprised 102 patients after total urinary resection. Survey questionnaire methodology was applied and patients were asked to fill a questionnaire form developed by the authors. Patients also participated in interviews. Additionally, medical records of all respondents were analysed. Almost half of the study group (47.1%) weren’t informed about the necessity of urinary diversion before their surgery. The site of the stoma wasn’t determined before the surgery in more than 50% of respondents (65.7%). Similar number of patients had no opportunity to zalearn about stoma equipment before the ileal conduit diversion. All respondents were informed how they should care of their urostomy. A strong correlation was found between peri-operational care and patients' level of knowledge and skills. Respondents who were taught about stoma care before their surgery presented higher levels of knowledge about self-care. Knowledge levels and practical skills regarding an ileal conduit diversion and stoma care were poor.