Factors Related to Adaptation to Cystectomy With Urinary Diversion

Background/Purpose

Bladder (urothelial) cancer patients undergoing urinary diversion (UD) experience significant changes that require important adjustments in their daily lives. This review identifies important factors that influence adaptation to life after cystectomy with the creation of a UD.

Methods

An integrative review was conducted through a review of primary research articles published between 1990 and 2014 using the PubMed and CINAHL Plus electronic databases.

Results

Findings were organized into five categories: (1) individual and family factors, (2) technical aspects related to the individual’s ability to care for his or her UD, (3) perioperative nursing care, (4) educational needs, and (5) symptom experience. Individual and family factors: family appears to play a major role in adaptation; many times they are relied on by the patient for assistance with management of the UD. Technical aspects related to the individual’s ability to care for his or her UD: instruction is needed on use of UD related appliances, irrigation equipment, catheters and solutions. Perioperative nursing care:  nurses play a pivotal role in site marking; perioperative educating, counseling and teaching. Wound Ostomy Nurses add an additional layer of expert support.  Educational needs: appropriate educational materials are needed; patients desire and seek out information related to their UD. Symptom experience: necessary to review expectations regarding postoperative symptom experience.

Conclusion

This integrative review identified multiple factors related to adaptation to reconstructed urinary system in bladder cancer survivors treated with cystectomy with a urinary diversion.  Findings provide a foundation for future research and interventions.