A patient has undergone a cutaneous urinary diversion procedure where the ureters are implanted into an isolated section of the terminal ileum, with one end brought to the abdominal wall to form a stoma. Which procedure does this describe?

1. A

   Cutaneous ureterostomy

2. B

   Ileal conduit

3. C

   Vesicostomy

4. D

   Nephrostomy

Appeared in: NORCET 6 mains-2024

Explanation

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• An ileal conduit is a specific type of incontinent urinary diversion where a segment of the small intestine (ileum) is used to create a passageway for urine.
• The procedure involves surgically isolating a piece of the terminal ileum, implanting the ureters into it, and bringing one end to the surface of the abdomen to form a stoma.
• This description perfectly matches the procedure detailed in the question stem, where urine is diverted through a piece of the ileum.
• Urine drains continuously from the stoma into an external collection appliance, as the patient no longer has voluntary control over urination.

Why Other Options Were Wrong

• Option A: A cutaneous ureterostomy involves attaching the ureters directly to the skin of the abdomen. It does not use a segment of the ileum as a conduit.
• Option C: A vesicostomy involves creating a direct opening from the bladder to the skin of the lower abdomen. It does not involve the ureters or the ileum.
• Option D: A nephrostomy is the placement of a tube directly into the kidney's renal pelvis to drain urine. It is a form of urinary drainage but not a reconstructive diversion using the bowel.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Types of Cutaneous Urinary Diversions to guide bedside assessment, documentation, and the next nursing action.
• Nurses must educate patients with an ileal conduit that the presence of mucus in the urine is a normal finding, as the intestinal segment used for the conduit continues to produce mucus.
• Stoma assessment is a critical nursing responsibility. A healthy stoma is pink to red and moist. Any discoloration (pale, dark red, purple, or black) must be reported immediately as it can indicate compromised blood flow.
• Protecting the peristomal skin is paramount. A properly fitted pouching system is essential to prevent urine from leaking onto the skin, which can cause severe irritation and breakdown.

How to Approach the Question

• First, carefully read the question and identify the key components of the surgical procedure described.
• Note the specific anatomical parts mentioned: 'ureters,' 'isolated section of the terminal ileum,' and 'stoma' on the 'abdominal wall.'
• Recognize that the use of the 'terminal ileum' is the most defining feature of the procedure.
• Evaluate each option based on this key feature.
• Cutaneous ureterostomy, vesicostomy, and nephrostomy do not involve using a segment of the ileum.
• Conclude that 'Ileal conduit' is the only procedure that matches the detailed description provided in the question.

Concept Tested & Keywords

• Concept Tested: Types of Cutaneous Urinary Diversions
• Stem keywords: cutaneous urinary diversion, ureters, implanted, terminal ileum, stoma
• Lead-in keywords: Which procedure

Question ID

QapBI1FpA-U2lB6RdH__iI

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 605-607