Urinary diversion
Temporary
[edit | edit source]- IDC
- Suprapubic catheter
Permanent
[edit | edit source]- Ileal conduit
- Isolate a 20cm coil of ileum, about 30cm from ICV (or less commonly, colon) with its blood supply intact
- Implant ureters into ileum either end to side or end to end
- The ileal conduit diverts the urine onwards to a cutaneous stoma for collection in an ileostomy bag
- Complications:
- Ureteroileal stricture
- Stenosis at ileocutaneous site - keep the conduit short
- Ureterosigmoidostomy
- Complication - cancer in sigmoid - seems to occur more when urine and faeces can mix, after about 15 years
- Ileal neobladder
Metabolic consequences of internal diversion
[edit | edit source]- Resorption of solutes
- Depends on the length of bowel exposed to urine, and the length of time that the urine is in contact with bowel epithelium
- Typically causes hyperchloraemic acidosis with potassium depletion
- Worse with ureterosigmoid diversion; less frequent problems with ileal conduit
- Malabsorption with reduction in ileal length - seems unlikely unless lots used
- Should monitor B12 and folate yearly