**2.2 Patient education and training**

280 Urinary Incontinence

Ultimately there is no hard and fast answer for every situation, rather an individualised

Physical examination should determine patient's cognitive capacity to perform self catheterisation. The body habitus may strongly influence the sitting position of the urinary stoma. Attention must be given on how the urine collecting bag plate will adhere to the patient's skin, whether it is going to adequately cope with the external abdominal wall when patient is sitting or standing, etc. It is a useful tip to delineate and mark the exact site where

Comorbidities that may impair patient's ability to properly heal such as uncontrolled

The description by McGuire and cols. [6] that storage leak point pressures above 40 cmH2O would jeopardize the integrity of the upper urinary tract set a reference value for urodynamic monitoring and treatment orientation. Urodynamics is also helpful in identifying or

Upper urinary tract preservation is the corner stone of dysfunctional voiding patient management. Upper tract evaluation can be simply performed through an abdominal ultrassonography which is a non invasive procedure that provides valuable information on kidneys morphological features such as shape and size, which may preclude congenital pathologies, anatomical variances, parenchymal scars, and others [1]; and serum labs (urea, creatinine). Creatinine clearance is also recommended to assess global renal function. Evidence of renal atrophy or changes in shape that might suggest impairment of renal function, including previous history of recurrent urinary tract infection (UTI) must be confirmed with static renal scintigraphy (DMSA). This will provide precise information on the patient's baseline renal function status at the beginning of treatment and allow for future monitoring and assurance of renal preservation through comparative analysis. Renal function deterioration is an important landmark to decide upon indicating a reconstructive procedure in this specific population. As such, it seems obvious that prevention of UTIs is critical. An adequate global renal function will reduce the chance for acid/base imbalances

Whenever ureteral dilation is identified, assessment with DTPA or MAG-3 scintigraphy is recommended to rule out ureteral obstruction which may occur as a consequence of bladder wall thickening as well as urethrocistography which will identify possible associated secondary vesicoureteral reflux. In these cases ureteral reimplantation may be needed. This evaluation will not only assure ureteral patency but also determine renal split function.

Urodynamic evaluation is mandatory when bladder dysfunction is suspected. When considering a catheterizable channel, one must be certain about the bladder normal capacity and compliance. Otherwise an augmentation procedure may be necessary in association. Also, continence evaluation may indicate the need for an anti incontinence procedure such as bladder neck closure. This is recommended when urinary leak pressures are detected below 30 cm H2O. Videourodynamics combine conventional urodynamics with contrast

imaging providing both functional and morphological information at once [4,15].

confirming detrusor overactivity and determining maximum capacity and compliance.

secondary to intestinal absorption. However, regular monitoring is needed.

the stoma should be before patient is taken to the operating room.

diabetes or immunodeficient states must be set even beforehand.

decision must be made.

**2.1 Pre operative evaluation** 

It is of utmost importance for patients to be adequately informed on the details involving intermittent self catheterization in order to avoid complications.

A review by Moore et al. [10] showed no convincing data favoring any specific catheterization technique (clean vs sterile), catheter type (coated vs uncoated), method (single vs multiple use) or person (self vs other). Different catheter types, materials and sizes can be tested depending on patient preference. Accessories may ease the procedure execution including catheter mirror, knee spreader with mirror, catheter holder. Regardless of using these, catheterization education and support is fundamental [11]. The nurse or physician should assess patient knowledge about the urinary tract; an overview of the perineum and urinary tract through pictures, figures and videos may be very helpful. Nurse should also assess the patient's ability to learn intermittent self-catheterization, awareness of problems related to it, motivation to continue long-term catheterization and the understanding of how to avoid possible complications [11].
