Terminal patients with urinary diversion: are there specific treatment or nursing care problems in the primary healthcare sector?
OBJECTIVE
To investigate the treatment and nursing care problems related to the type of urinary diversion in terminal patients experienced by the primary healthcare sector.


METHODS
A questionnaire about treatment and nursing care problems related to urinary diversion was sent to general practitioners (GPs) and district nurse units (DNUs) that had been in contact with 1 of 71 patients who died following cystectomy in a 5-year period. The patients had 1 of 3 types of urinary diversion: ileal conduit (IC), Indiana pouch (IP), or Hautmann orthotopic neobladder (NB).


RESULTS
Both GPs and DNUs reported significant difference in problems associated with the 3 types of urinary diversion favoring the IC (P = .049 and .025, respectively). However, clinical decisions about urinary diversion types are often based on incontinent versus continent diversions. When divided into continent versus incontinent diversions, the analysis revealed no differences in the number of problems (P = .31 and .052, respectively). Comparing IC and NB alone made the difference even less significant (P = .82 and .23, respectively).


CONCLUSIONS
It seems that there are no major disadvantages with one type of urinary diversion when compared to the other as perceived by primary healthcare providers. Relevant and thorough information should be provided to GPs and DNUs in order to minimize problems with all forms of urinary diversion.
Jensen
Jørgen Bjerggaard
JB
Department of Urology, Aarhus University Hospital, Skejby, Denmark. jb@skejby.net
Kiesbye
Berit
B
Jensen
Klaus Møller-Ernst
KM
D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010821:Physicians, Family; D011320:Primary Health Care / Q000592:standards*; D011368:Professional-Family Relations; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000451:nursing*