Definition of Terms - 2

An opening at the bottom of this pouch is attached to the anus such that the existing anal sphincter muscles can be used for continence. This procedure should only be performed on patients with ulcerative colitis or familial polyposis, and who have not previously lost their rectum or anus. It is also called J-pouch, pullthrough, endorectal pullthrough, pelvic pouch, or a combination of these terms.

Continent Ileostomy - This surgical variation of the ileostomy is also called a Kock pouch. A reservoir pouch is created inside the abdomen with a portion of the terminal ileum.

A valve is constructed in the pouch which is brought through the abdominal wall A catheter or tube is inserted into the pouch several times a day to drain feces from the reservoir. This procedure has generally been replaced in popularity by the ileoanal pouch. A newer version of this procedure called the Barnett Continent ileal Reservoir is practiced at a limited number of facilities.

Urostomy - This is a general term for a surgical procedure which diverts urine away from a diseased or defective bladder. The ileal or cecal conduit procedures are the most common urostomies. Either a section at the end of the small bowel (ileum) or at the beginning of the large intestine (cecum) is surgically removed and relocated as a passageway (conduit) for urine to pass from the kidneys to the outside of the body through a stoma. It may include removal of the diseased bladder. Other common names are the ileal loop or the colon conduit.

Continent Urostomy - There are two main continent procedure alternatives to the ileal or cecal loop (others exist). In both the Indiana and Kock Pouch versions, a reservoir or pouch is created inside the abdomen with a portion of either the smaller or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.

In the Indiana Pouch version the ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch which is made from the large bowel. With a Kock Pouch version, which is similar to that used as an ileostomy alternative, the pouch and a special "nipple" valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted.

B. Types of Appliances.

The term appliance refers to the combination of a flange (barrier or wafer) and pouch (or collection bag or reservoir). Often the entire appliance is called a pouch.

The appliance attaches to the abdomen by the adhesive backed faceplate and is fitted over and around the stoma to collect the diverted output, either feces or urine. Other common terms for the barrier are wafer, faceplate, flange, disc, body holder, mounting ring or adhesive ring. The barrier is made from either soft molded rubber or plastic, which together with its karaya, pectin or other adhesive backing, is designed to protect the skin from the stoma output and to be as neutral to the skin as possible.

Colostomy and ileostomy pouches can be either open-ended, requiring a closing device usually called a clamp or tail clip; or closed and sealed at the bottom. Open-ended pouches are called drainable and are reused after they are emptied. Most commonly closed end pouches are used by colostomates who can irrigate (see below), or by patients who have regular elimination patterns.

Closed end pouches are usually discarded after one use.

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