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Minerva Urology and Nephrology 2021 Jun 11

DOI: 10.23736/S2724-6051.21.04379-2


lingua: Inglese

Surgical management of urinary diversion and stomas in adults: multidisciplinary Italian panel guidelines

Alessandro TAFURI 1, 2 , Fabrizio PRESICCE 3, Marco SEBBEN 4, Francesco CATTANEO 5, Riccardo RIZZETTO 1, Francesco FERRARA 6, Andrea BONDURRI 7, Marco VELTRI 8, Maria BARBIERATO 9, Francesco PATA 10, Cristiana FORNI 11, Gabriele ROVERON 12, Gianluca RIZZO 13, Dario PARINI 14, on behalf of Multidisciplinary Italian Study group for STOmas (MISSTO)

1 Department of Urology,Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy; 2 Department of Neuroscience, Imaging and Clinical Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy; 3 Department of Urology, San Filippo Neri Hospital, Rome, Italy; 4 Department of Urology, Ospedale Sacro Cuore Don Calabria IRCCS, Negrar, Verona, Italy; 5 Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy; 6 Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy; 7 Department of General Surgery, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy; 8 General Surgery Unit, San Jacopo Hospital, Pistoia, Italy; 9 Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy; 10 General Surgery Unit, N. Giannettasio Hospital, Corigliano-Rossano, Cosenza, Italy; 11 Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; 12 Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy; 13 Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; 14 General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy


BACKGROUND: Urinary stomas represent a worldwide medical and social problem. Data from literature about stoma management are extensive, but inhomogeneous. No guidelines exist about this topic. So, clear and comprehensive clinical guidelines based on evidence-based data and best practice are needed. This article aims to elaborate guidelines for practice management of urinary stomas in adults.
METHODS: Experts guided review of the literature was performed in PubMed, National Guideline Clearing-house and other databases (updated March 31, 2018). The research included guidelines, systematic reviews, meta-analysis, randomized clinical trials, cohort studies and case reports. Five main topics were identified: “stoma preparation”, "stoma creation”, “stoma complications”, “stoma care” and “stoma reversal”. The systematic review was performed for each topic and studies were evaluated according to the GRADE system, AGREE II tool. Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low level of scientific evidence statements a consensus conference composed by expert members of the major Italian scientific societies in the field of stoma management and care was performed.
RESULTS: After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines with definitive recommendations was elaborated and prepared for publication. This manuscript is focused on statements about surgical management of urinary stomas. These guidelines include recommendations for adult patients only, articles published in English or Italian and with complete text available.
CONCLUSIONS: These guidelines represent the first Italian guidelines about urinary stoma multidisciplinary management with the aim to assist urologists and stoma specialized nurses during the urinary stoma management and care.

KEY WORDS: Urinary stoma; Radical cystectomy; Urinary stoma management; Multidisciplinary guidelines

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