COMPLICATIONS OF URINARY DIVERSION

GOVINDARAJAN

PG UROLOGY

SRMC

COMPLICATIONS1.COMP. DUE TO THE INTESTINAL

ANASTOMOSIS2.COMP. OF THE USED SEGMENT OF

INTESTINE3.COMP. OF THE STOMA4.COMP. OF THE URETEROINTESTINAL

ANASTOMOSIS5.COMP. DUE TO URINAY DIVERSION.

COMPLICATION IN GEN.(AS WITH ANY INTESTINAL SURGERY)

• FISTULA : urinary / fecal.USUALLY SEEN WITHIN FIRST FEW WEEKS POSTOP

• SEPSIS/INFECTION :wound dehiscence , pelvic abscesses .

• OBSTRUCTION : Incidence: 10% FOR ILEUM/STOMACH AND 5% FOR

COLON Causes ADHERSION,RECURENCE OF

MALIGNANCY,VOLVULUS,INTERNAL HERNIA,STENOSIS,OBSTRUCTION AT ANASTOMOTIC LINE.

•

COMPLICATION IN GEN.(AS WITH ANY INTESTINAL SURGERY)cont..

• HEMORRAGE Relatively rare. due to failure to secure bleeding points at time of

surgery/ anastomotic ulcer

• INTESTINAL STENOSIS : EARLY : due to techniqual defect/edema LATE : due to ischemia/perienteric infection

• OGILVIE SYNDROME : Usually seen within 3rd POD.X-RAY abd. When cecum is >12 cm chance of rupture

COMPLICATION RELATED TO THE SEGMENT

• STRICTURE TIME OF PRESENTATION ( usually late)

ETIOLOGY (exposure to urine/lymphoid depletion / persist. Infection/submucosal fibrosis )

RENAL DETERIORATION

• ENLONGATION OF THE SEGMENT Usually distal obstruction is present Increased pressure within the duct

RENAL DETERIORATION VOLVULUS

COMPLICATIONS OF STOMA

• SKIN(a.irritativehypo/hyperpigmentation, b.erythematous macular/scaling

c.pseudoverrucous wartlike lesions).• STOMAL STENOSIS(ileum 20-24 % ,colon 10-20 % ,). • PARASTOMAL HERNIA end stoma 1-4% and loop stoma

4-20%.• BLEEDING FROM VARICES• STOMAL PROLAPSE• STOMAL RETRACTION• STOMAL OBSTRUCTION

COMPLICATION OF URETEROINTESTINAL ANASTAMOSIS

• URINARY FISTULA : common 7-10 days postop, incidence of 3-9% this can cause periureteric fibrosis & stricture• STRICTURE : more common in antireflux anastomosis(more

common in left ureter under IMA)• PYELONEPH : seen early post op and late stage also.Incidence : ileum 12% & colon 13%.• RENAL DETERIORATION :seen in 10-60%. due to ?anastomosis/intrinsic defect in kidney. .incidence is 18% in ileum & 15% in colon

COMPLICATIONS OF CONDUIT(urine storage)

ILEAL CONDUIT BLEEDING HYPERTENSION/RENAL FAILURE OTHERSJEJUNAL CONDUIT MAINLY ELETROLITE ABNORMALITYCOLON CONDUIT RENAL FAILURE , DIARROHEA,

METABOLIC COMPLICATIONS

1. ALTERED SENSORIUM2. ALTERED DRUG ABSORPTION3. OSTEOMALASIA4. INFECTION5. ELECTROLYTE ABNORMALITY6. STONES7. INTESTINAL MOTILITY/SHORT GUT SYN.8. CANCER

ELECTROLYTE ABNORMALITY

STOMACH: HYPOCHLOREMIC HYPOKALEMIC

ALKALOSIS

PROBLEM IN CRF…………..

TREATMENT

JEJUNUM : HYPONATREMIC HYPOCHLOREMIC HYPERKALEMIC ACIDOSIS

DEHYDRATION……RENIN/ALDOSTERONE

ILEUM & COLON :HYPERCHLOREMIC ACIDOSIS

URETEROSIGMOID :DIARROHEA,HYPOKALEMIA

DUE TO CRF/OSMOTIC DIURESIS/INTEST.

SECRETION /POOR REABSORPSION BY COLON

ALTERED SENSORIUM

• MORE COMMON IN URETEROSIGMOIDOSTOMY• MAGNESIUM DEFICIENCY• DRUG INTOXICATION• ABNORMAL AMMONIA METABOLISM• DIABETIC HYPERGLYCEMIATREATMENT : CBD & NEOMYCIN DECREASE PROTEIN INTAKE IV ARGININE GLUTAMATE 50 mg IN 1000ml

DNS / LACTULOSE

OSTEOMALACIA

• ACIDOSIS

• DEFECT/RESISTANCE TO VIT D

• SULFATE METABOLISM ALTERATION

TREATMENT

NUTRITIONAL DISORDERS• VIT B 12 DEFICIENCY• BILE ACID METABOLISM. DEFECT• FATTY ACID METABOLISM DEFECT• LOSS OF ILEAL BREAK• BACTERIAL COLONISETION• JEJUNUM-FAT,CALCIUM.FOLIC ACID

DEFECTS

CANCER

• URETEROSIGMOID INCIDENCE : 6-29 % (AVERAGE OF 11%).

• 10 – 20 YEAR LAG PERIOD• CAN BE ADENOCARCINOMA,ADENOMATOUS

POLYP, SARCOMA , TCC , ANAPLATIC MALIGNANCY

• ?ORIGIN FROM TRANSITIONAL EPITHELIUM

OTHERS…………• ABNORMAL DRUG METABOLISM

• GROWTH AND DEVELOPMENT

• INFECTIONS

• STONES : MG,CA,AMM,PHOS

seen commonly with hyperghloremic acidosis,pyelonephritic kidney,UTI with urea splitting organism

• THANK YOU.