Urinary Diversions

1
Urinary Diversions

• ??' ???? ???????
• 6.3.06

2
???? ????? ????
3
Conduit urinary diversion
4
????? ??? ??????

• ????? ??????
• ????? ??? ??
• ?????? ?? ????
• ????? ???? ???? ?? ???
• ???? ??????? ???? ???? ????????
• ?????? ???? ??????
• 30 ???? ??????? 20-56
• ???? 30 ???? 28-81

5
??????? ??????? ????

• ?????? ????? (?? 20)
• ????? ????? ?????? ????? ?????? ?????
• ????? ????? (5-10)
• ?????????
• ??? ????? ?? ??? ?????
• ??? ?????? (1-5)
• ???????, ??????, ??????????, IBD, ??? ?? ?????,
  ????? ???????
• ???????

6
??????? ??????? ??????

• ???
• ??? ????? ???????
• ????? ?? ?????? ??? ?? ????
• ??????
• ????? ?????
• ???? ????????
• ?????
• ?????

7
??????? ??????? ??????

• (???????? ??????? ?????? ??????)
• ???
• ?????
• ?????
• ??????
• ???
• ?????

8
??????? ??????? ????? ????? ????

• ??????? ?????
• ????? ??????? ???? ??? ????? ???????
• ?????? ??? 2
• ?????? ?? ????? (4-7)
• ???? ????
• ???? ????? ?????? ?????? ?????
• ??????-??????????

9
Continent diversions
10
?????

• Ureterosigmoidostomy (and variations)
• Continent diversions requiring clean intermittent
  catheterization

11
????? ??? ??????????

• ????? ????????? ?????.
• ???? ????? ??????? ?? ?????.
• ????? ???? ???????.
• ???????????? ????? ?????? ???? ??.

12
??????? ??????? ?????

• ????? ????? (10)
• ????????? ??????
• ????? ?? ???
• ????? ???
• ?????? ????????
• ????? ???? (????? ????????)
• ?????? ????? ???? ?????? ?????? ??????????
• ?????? ????? ?- Kock pouch

13
??????? ??????? ?????

• ??? ??? ????? ???? ?????? (?? 10)
• ????? ????? ???? ??????
• ??????? ???????? ?? ?????
• ??? ????? ???????
• ????? ?????? ?????? ??????

14
?? ????? ?? ??? ???

• ?????????? ?? ????? ????? ????????????
• ????? ????? ???? ???? ????? ???????
• ?????? ????? ?? ???? ???????
• ???????
• ???????, ???????? ?? ??????? ?????? ??????
  ????? ???????

15
??????? ?? ?????/???? ???????

• ???? ??????????
• ?????? ?? ????? ????????
• ????? ????? ??????? ???? ???????????? ??????
  ?? ??????

8
16
??????? ??????? ????? ????? ????

• ??????? ?????
• ?????? ?? ????? ???? ????
• ???? ????? ?????? ?????? ?????
• ????? ??????? ??????????

17
Ureterosigmoidostomy

• ??????? ?????????
• ????? ?? ???????
• ?? ????? ?????
• ????? ????
• ?????? ????
• ????????????
• ?????? ????? ?? ?????

18
Ureterosigmoidostomy

• ???? ??????? ???????????
• ????????? ?? ????????
• ????????????
• ?????? ??? ??

19
Ureterosigmoidostomy

• Folded Rectosigmoid Bladder

20
Ureterosigmoidostomy

• Augmented Valved Rectum

21
Ureterosigmoidostomy

• Hemi-Kock and T-Pouch Procedures with
  Valved Rectum

22
Ureterosigmoidostomy

• Sigma Rectum Pouch Mainz II
• (mixed augmentation ileum and cecum)

23
Continent Catheterizing Pouches

• Kock pouch

24
Continent Catheterizing Pouches

• T-Pouch

25
Continent Catheterizing Pouches

• Right Colon Pouches with Intussuscepted Terminal
  Ileum
• UCLA
• Duke
• LeBag

26
Continent Catheterizing Pouches

• Indiana pouch
• Florida (Tampa)
• Miami

27
Continent Catheterizing Pouches

• Penn pouch

28
Continent Catheterizing Pouches

• Gastric pouches

29
Orthotopic urinary diversions
30
?????? ????????? - ???????

• ???? ?????
• ??? ????
• ????? ?? ??? ???
• ??? ???? ??????????
• ????? ??????? ???? ?????, ???? ????? ??????,
  ????? ??????, ????? ??? ????? ????? ???? ??

31
????? ?? ??? ???

• ?? ????? ????? ???? (13)
• 15-25 ?? ????? ??? (stress incontinence)
• 5 ?? ????? ????
• ?? ????? ????? ?????
• ?? 50 ?? ?????
• ???? ?????????? ??? ????? ??? (8)
• ???? ?????????? ??? ???????? ?? ???? (4-25)

32
??????? ??????? ?????

• ????? ????? (0.5-3)
• ????????? ??????
• ????? ?? ???
• ????? ???
• ?????? ????????
• ????? ???? (????? ????????)
• ?????? ????? ?- Kock neobladder (10-30)

33
??????? ??????? ?????

• ??? ??? ????? ???? ?????? (3)
• ????? ????? ???? ??????
• ?? ????? ????? ???? ????????
• ???????
• ?????? ?????
• Neobladder-vaginal fistula

34
??????? ??????? ????? ????? ????

• ??????? ?????
• ?????? ?? ????? (?? 10)
• ???? ??? ????? ???? ?????
• ???? ????? ?????? ?????? ?????
• ?????? ????? ???? ?????? ??????? ??????????

35
Orthotopic diversions

• Camey II and modifications

36
Orthotopic diversions

• Hautmann pouch

37
Orthotopic diversions

• Studer Ileal Bladder Substitute

38
Orthotopic diversions

• Orthotopic Kock Ileal Reservoir

39
Orthotopic diversions

• Serous-Lined Extramural Tunnel

40
Orthotopic diversions

• T-Pouch Ileal Neobladder

41
Orthotopic diversions

• Orthotopic MAINZ Pouch
• (mixed augmentation ileum and cecum)

42
Orthotopic diversions

• Ileocolonic (LeBag) Pouch