From the Guidelines
Ileostomy and ileal conduit are two distinct surgical procedures with different indications and management strategies, and patients undergoing these procedures require careful monitoring and specialized care to prevent complications and maintain quality of life. When considering the management of patients with ileostomies, it is crucial to prioritize the prevention of short-term complications such as early high ostomy output (HOO) and ostomy leakage, as these can significantly impact morbidity, mortality, and quality of life 1. Some key considerations for managing ileostomies include:
- Prompt evaluation for infection, ileus, or medication-related adverse effects in the context of high ostomy output
- Hydration to prevent renal failure, which may require hospital admission or long-term intravenous access placement for home health care
- Medical treatments for early HOO, as described in Table 1 of the study by 1
- Prevention of ostomy leakage through preoperative marking by a stomatherapist, meticulous surgical technique, and proper pouching techniques
- Management of leakage through thickening the stool with antidiarrheals, using convex appliances, ostomy belts, paste, or barrier rings, and ensuring proper peristomal skin care. In contrast, ileal conduits are used for urinary diversion and require specialized care to prevent complications such as urinary tract infections, kidney stones, and metabolic disturbances. Regular follow-up with healthcare providers is essential to ensure proper stoma function, address any complications promptly, and maintain optimal quality of life for patients with ileostomies and ileal conduits 1.
From the Research
Ileostomy and Ileal Conduit
- An ileal conduit is a type of urinary diversion that involves the creation of a stoma from the small intestine to divert urine out of the body 2.
- Ileovesicostomy is a procedure that involves the creation of a conduit between the ileum and the bladder to manage neurogenic bladder dysfunction, and it can be converted to an ileal conduit if necessary 2.
- The use of prophylactic antibiotics after ileal conduit urinary diversion with cystectomy has been shown to not reduce the incidence of urinary tract infection-related complications, and may even increase the risk of Clostridium difficile infections 3.
Complications and Management
- Common complications of ileal conduit urinary diversion include urinary tract infections, stomal stenosis, and bladder and kidney stone formation 2, 3.
- The use of urease inhibitors such as acetohydroxamic acid has been shown to be effective in reducing the formation of urinary stones and the virulence of bacteria in patients with urea-splitting urinary infections 4, 5, 6.
- Acetohydroxamic acid has been shown to be well tolerated and effective in reducing urinary ammonia and alkalinity in patients with staghorn renal calculi and urea-splitting urinary infection 5.
Surgical Considerations
- Ileovesicostomy can be safely performed in neurologically impaired women and men, but severe preoperative detrusor hyperreflexia with urge incontinence appears to be a risk factor for persistent urge incontinence postoperatively in women 2.
- The ileal conduit can be converted to a conventional ileal conduit if necessary, and the ileal "chimney" can be excised and the patient's original lower urinary tract preserved in cases of neural recovery 2.