January 4th, 2016
The anatomy of the human urinary tracts includes two kidneys, two ureters, one urinary bladder and a urethra. Kidneys perform the function of making urine by filtering the blood, which then passes to the bladder through hollow tubes, known as ureters. When the bladder gets filled completely, the reflex of micturition (urination) helps in emptying the bladder with the help of the urethra.
If there is an organic disease process anywhere along the urinary system, the normal physiology is altered. In all such cases, your surgeon will have to create an alternative pathway to expel the toxic nitrogenous products in the urine to minimize the risk of complications. For example, after major surgical procedures like bladder removal (for the management of a malignant lesion or other indications), surgeons usually create a pathway for the urinary excretion from the body by a process known as urinary reconstruction and diversion.
Most common urinary diversion surgeries are as follows:
1. Ileal conduit urinary diversion: It is the diversion of urine to the ileum.
Procedure: In this procedure, the ureters drain urine directly into the terminal ileum, which is then brought to the exterior via a stoma in the abdominal wall.
Merits:
Demerits:
2. Indiana Pouch Reservoir: it is the diversion of urine to the large intestine and portions of ileum.
Procedure: In this procedure, a pouch is made from the colon (mainly ascending part or from part of ileum). That pouch serves as the reservoir of urine. The ureters flow directly into the pouch, from where it is then removed by a small stoma made on the abdominal wall. A catheter is used every 4-6 hours to empty the pouch. Catheter is passed from the stoma into the pouch, for emptying purpose. The catheter does not need to be sterilized, but should be washed thoroughly after every use. Stoma is covered by a bandage.
Merits:
Demerits:
Neobladder to Urethra Diversion: The storage function of bladder is preserved in this surgery.
Procedure: In this procedure, a small pouch is made from the small intestine (just like Indiana pouch reservoir). The pouch is connected directly to the ureters on the proximal end and to the urethra on the distal end. Hence the urine flows from kidney to ureters, from the ureters to the pouch, and from the pouch to the exterior via urethra as in a normal person expelling urine. A catheter must be passed if the urine flow stops at any time, or to empty the pouch if necessary.
Merits:
Demerits:
Immediate Post- Operation Period:
1. Sofos, S. S., Walsh, C. J., Parr, N. J., & Hancock, K. (2015). Radical cystectomy and pelvic lymphadenectomy with ileal conduit urinary diversion and abdominal wall reconstruction: an interesting case of multidisciplinary management. International medical case reports journal, 8, 29.
2. Shimko, M. S., Tollefson, M. K., Umbreit, E. C., Farmer, S. A., Blute, M. L., & Frank, I. (2011). Long-term complications of conduit urinary diversion. The Journal of urology, 185(2), 562-567.
3. Wuethrich, P. Y., Burkhard, F. C., Stueber, F., & Studer, U. E. (2014). Blood loss is reduced in patients undergoing open radical cystectomy and urinary diversion with a low pelvic venous pressure: a secondary analysis of a randomized clinical trial: 6AP4‐2. European Journal of Anaesthesiology (EJA), 31, 99.
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