A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client’s understanding of the surgical procedure by explaining that an ileal conduit:
A. Is a temporary procedure that can be reversed later.
B. Diverts urine into the sigmoid colon, where it is expelled through the rectum.
C. Conveys urine from the ureters to a stoma opening in the abdomen.
D. Creates an opening in the bladder that allows urine to drain into an external pouch.
Correct Answer: C. Conveys urine from the ureters to a stoma opening in the abdomen.
An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible.
Option A: Commonly, a permanent urinary diversion is created after surgery to treat a bladder or pelvic malignancy, but it can be performed for other functional and anatomical abnormalities of the urinary tract. Ileal conduits are the most common form of incontinent urinary diversion, other options providing continent urinary diversion do exist, and these are more widely practiced in America, whereas in Europe, ileal conduits are preferred.
Option B: Diversion of the urine to the sigmoid colon is called a ureter ileosigmoidostomy. When bladder cancer is treated with curative intent, continence-preserving orthotopic urinary bladder replacement is preferred. For heterotopic urinary bladder replacement, a reservoir is fashioned from an ileal or ileocecal segment. Urine is diverted to the rectum by way of the sigmoid colon.
Option D: An opening in the bladder that allows urine to drain externally is called a cystostomy. Cystostomy is the general term for the surgical creation of an opening into the bladder; it may be a planned component of urologic surgery or an iatrogenic occurrence. Often, however, the term is used more narrowly to refer to suprapubic cystostomy or suprapubic catheterization.
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