Cuidados de enfermería en un paciente intervenido de neovejiga ileal ortotópica tipo Hautmann. Caso clínico / No disponible

Entre las derivaciones urinarias en pacientes sometidos a una cistectomía radical por cáncer vesical infiltrante, la neovejiga ileal ortotópica, tipo Hautmann, es una excelente alternativa. Como objetivos nos planteamos: 1) exponer los cuidados de enfermería en pacientes intervenidos de cistectomía radical por cáncer vesical infiltrante a los que se les ha construido una neovejiga ileal tipo Hautmann, y 2) señalar el importante papel que juega enfermería, tanto hospitalaria como de atención primaria, en este tipo de intervención quirúrgica. Se expone un caso clínico de un paciente diagnosticado de cáncer urotelial papilar de alto grado con infiltración perineural al que se le ha construido una neovejiga. Se muestra el procedimiento seguido en el servicio, así como los protocolos empleados y actuaciones de enfermería. Como complicación presentó un íleo paralítico. La bibliografía especializada señala que el íleo paralítico es una de las complicaciones inmediatas que se da con más frecuencia en la cistectomía radical por cáncer vesical infiltrante, junto con la fístula urinaria, retención urinaria por mucus y urosepsis. Estudios de seguimientos de casos de neovejiga ileal tipo Hautmann muestran buenos resultados funcionales, una baja tasa de complicaciones, tanto inmediatas como tardías, y, sobre todo, una buena calidad de vida de estos pacientes

Orthopic ileal neobladder, type Hautmann, is currently the preferred method for urinary derivation in patients undergoing radical cystectomy for muscle-infiltrating bladder cancer. We set goals such as: 1) to supply useful information to patients with neobladder, specifically Hautmann neobladder about patients who underwent radical cystectomy due to infiltrating bladder cancer. 2) to highlight the important role that nursing staff plays by promoting quality in nursing care in this type of surgical intervention. It is described the case of a patient diagnosed with high-grade papillary urothelial carcinoma with evidence of perineural invasion. This patient underwent a radical cystectomy with neobladder reconstruction. The patient presented paralytic ileus. Paralytic ileus is a severe complication resulting from a variety of disorders, which is most commonly associated with radical cystectomy due to infiltrating bladder cancer. Other complications are urinary fistula, urinary retention due to mucus and urosepsis. Surveys aimed at monitoring the Hautmann neobladder show good functional outcomes, a low rate of complications of both immediate and late responses, and therefore, the quality of life for these patients was good

Clinical and Economic Burden of Peristomal Skin Complications in Patients With Recent Ostomies.

PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications.

Urostomy appliances and stoma care routines. The relation to peristomal skin complications.

The aim of the study was to describe types of appliances and stoma care routines and evaluate their relation to peristomal skin complications. Sixty-six patients with a cutaneous uretero-ileostomy were interviewed and the peristomal skin was assessed according to Classification of Peristomal Skin (CPS). The results show a conservatism regarding the types of appliance and the stoma care routines. More than half of the patients used the same product at follow-up as they were initially fitted with three to 14 years earlier. The routines adopted by the patients were often inadequate, resulting in skin complications. Continuous exposure of the skin to urine by creation of a too wide opening in the face-plate and infrequent changing of the appliance resulted in development of pseudoverrucose skin lesions.