COMPLICATIONS OF URINARY DIVERSION

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COMPLICATIONS OF URINARY DIVERSION

• GOVINDARAJAN
• PG UROLOGY
• SRMC

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COMPLICATIONS

• 1.COMP. DUE TO THE INTESTINAL ANASTOMOSIS
• 2.COMP. OF THE USED SEGMENT OF INTESTINE
• 3.COMP. OF THE STOMA
• 4.COMP. OF THE URETEROINTESTINAL ANASTOMOSIS
• 5.COMP. DUE TO URINAY DIVERSION.

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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,OBSTR
  UCTION AT ANASTOMOTIC LINE.

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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 gt12 cm chance of
  rupture

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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

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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

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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

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COMPLICATIONS OF CONDUIT(urine storage)

• ILEAL CONDUIT
• BLEEDING
• HYPERTENSION/RENAL FAILURE
• OTHERS
• JEJUNAL CONDUIT
• MAINLY ELETROLITE ABNORMALITY
• COLON CONDUIT
• RENAL FAILURE , DIARROHEA,

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METABOLIC COMPLICATIONS

1. ALTERED SENSORIUM
2. ALTERED DRUG ABSORPTION
3. OSTEOMALASIA
4. INFECTION
5. ELECTROLYTE ABNORMALITY
6. STONES
7. INTESTINAL MOTILITY/SHORT GUT SYN.
8. CANCER

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ELECTROLYTE ABNORMALITY

• STOMACH HYPOCHLOREMIC HYPOKALEMIC
• ALKALOSIS
• PROBLEM IN CRF..
• TREATMENT
• JEJUNUM HYPONATREMIC HYPOCHLOREMIC HYPERKALEMIC
  ACIDOSIS
• DEHYDRATIONRENIN/ALD
  OSTERONE
• ILEUM COLON HYPERCHLOREMIC ACIDOSIS
• URETEROSIGMOID DIARROHEA,HYPOKALEMIA
• DUE TO CRF/OSMOTIC
  DIURESIS/INTEST.
• SECRETION /POOR REABSORPSION
  BY COLON

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ALTERED SENSORIUM

• MORE COMMON IN URETEROSIGMOIDOSTOMY
• MAGNESIUM DEFICIENCY
• DRUG INTOXICATION
• ABNORMAL AMMONIA METABOLISM
• DIABETIC HYPERGLYCEMIA
• TREATMENT CBD NEOMYCIN
• DECREASE PROTEIN INTAKE
• IV ARGININE GLUTAMATE 50 mg IN 1000ml
  DNS / LACTULOSE

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OSTEOMALACIA

• ACIDOSIS
• DEFECT/RESISTANCE TO VIT D
• SULFATE METABOLISM ALTERATION
• TREATMENT

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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

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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

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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

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• THANK YOU.