الفهرس 
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Abstract
SUMMARY
Urinary diversion are performed to divert urine from the bladder to a new exit site, usually through a surgically created opening (stoma) in the skin. These procedures are primarily performed when a bladder tumor necessitates removal of the entire bladder (cystectomy) (Afak, Wazir, Wani, and Aziz, 2009).
There are two categories of urinary diversion: cutaneous urinary diversion, in which urine drains through an opening created in the abdominal wall and skin and continent urinary diversion, in which a portion of the intestine is used to create a new reservoir for urine (Afak, Wazir, Wani, and Aziz, 2009).
Aim of the study:
The aim of the study was to assess the needs of patients undergoing urinary diversion prior and post operation as regarding to physical, psychological, social, financial needs, and observed needs.
Methodology:
a. Setting of the study:
This study was conducted in urology unit at El-Demerdash Hospital , Ain shams university as well as Urology and Nephrology Center at Mansoura University Hospitals.
b. Subjects of the study:
A representative subject of 100 adult patients from both setting undergoing urinary diversion were recruited for the conduction of this study regardless to their gender, residence, occupation, or level of education.
c. Tools for data collection:
Data were collected using the following tools:
1) Patient’s needs assessment questionnaire was developed and designed by researcher to assess needs of patients undergoing urinary diversion based on the literature review. It was validated, reliable and utilized by the researcher to collect the necessary data.
2) Observational Checklist to assess patients’ response (Observed Needs).
d. Pilot study:
The pilot study was applied on a group of 10 patients based on statistical percentage to test content applicability and clarity of the tools. Based on the results of the pilot study, some modifications were carried out.
Result:
The main study findings can be summarized as the following:
• More than half of the studied subject was in age group of (40-60) years, and more than four fifth of the subjects were male, and the majority of the studied subjects were married.
• Regarding working status more than half of the studied subjects were not working, and more than two fifth of them was illiterate, while nearly three fifth of patients had monthly income <300.
• Most of the studied subjects were suffering from psychological problems caused by the surgery.
• Majority of the subjects their income can not cover their needs, in addition to more than four fifth of them did not having governmental support.
• All of the studied subjects (100.0%) had unsatisfactory level of knowledge about urinary diversion.
• All of the studied subjects (100%) had unsatisfactory financial needs, and more than half of the studied subjects had unsatisfactory social needs.
• As regarding to general mean scores of needs for subjects undergoing urinary diversion, it was showed that the highest needs were the physical needs with mean percentage 96.93 ± 20.34 followed by observed needs with mean percentage 13.61 ± 3.51; psychological needs with mean percentage 12.66 ± 1.94; social needs with mean percentage 10.03 ± 3.31 and financial needs with mean percentage 5.88 ± 0.33.
• Male subjects had more physical and social needs than female subjects and, there is statistical significant difference between sex and physical needs of studied sample (at p value 0.034).
• Working subjects had social needs more than not working subjects and, with highly statistical significant difference at (p value 0.000).
• There was highly statistical significant difference between patients’ diagnosis and physical needs, at (p value 0.000).
• There was highly statistical significant difference between diagnosis and psychological needs at (p value 0.005) and observed needs at (P value 0.000) of studied subjects.
Based on the results of the present study, the following can be concluded:
• All of the patients included the in study (100%) had unsatisfactory level of knowledge about urinary diversion.
• The highest detected needs among the study group were the physical needs, followed by the psychological, than social and lastly the financial needs.
• There is statistical significant relation between patient’s age and his physical; observed needs.
• There is statistical significant relation between patient’s gender and his physical needs, and social needs.
• There is highly statistical significant relation between patient’s occupation and his social needs.
• There is statistical significant relation between patient’s educational level, and his physical; social; and observed needs.
• There is statistical significant relation between patient’s residence and his observed needs.
Recommendations:
from the study finding we could recommend the following:
(1) Periodic health teaching programme for patients with urinary diversion and their families should be held to update the knowledge about self management
(2) Prospective follow up studies are needed to develop and refine interventions to improve self management.
(3) A psychological health program and psychiatric team should be planned to help such group of patient and their family to adapt with the changes occur after surgery.
(4) Further research must focus on self management for urostomy and orthotopic urinary diversion.
(5) Provide adequate information about urinary diversion for patients undergoing such intervention will faster the cope with the situation.