Ureterosigmoidostomy
Encyclopedia
A ureterosigmoidostomy is a surgical
procedure where the ureter
s which carry urine from the kidney
s, are diverted into the sigmoid colon
. It is done as a treatment for bladder cancer
, where the urinary bladder
had to be removed. Rarely, the cancer presents in children between the ages of 2 & 10 yrs old as an aggressive rhabdomyosarcoma, although there are diagnoses of children as young as 3 months old. The procedure was also used several decades ago as a correctional procedure for patients born with bladder exstrophy
. In the case of some bladder exstrophy patients, occasional bowel incontinence
(in this case, a mixture of urine and feces similar to diarrhea) at night is one uncontrollable consequence.
Another consequence of this procedure is an increased risk of kidney infections (nephritis
) due to bacteria
from faeces travelling back up the ureters (reflux). Patients are commonly put on oral prophylactic antibiotics to combat infections in the uretery tract and the kidneys but this can lead to tolerance of the antibiotic, so over time the patient can build up tolerance to a large number of oral antibiotics, leading to a need for IV (intravenous) antibiotics administered while the patient is an inpatient.
As well as this, the urine entering the colon can cause diarrhea and salt imbalance due to the sodium
and chloride
in the urine. Urea
levels in the blood
are higher due to urea crossing the colon wall. In the large intestine
, sodium is swapped for potassium
, and chloride for bicarbonate
, this causes an acidosis
and hypokalaemia. Many patients take sodium bicarbonate to combat this.
Patients with ureterosigmoidostomy have an increased chance of developing carcinoma of the colon after living with the modification for a number of years, on average 20–30 years after the operation, which can also lead to severe surgical adhesions.
This operation is no longer popular in many countries, with an ileal conduit (where the ureters lead into a loop of small intestine
) being preferred. However, it is still popular in developing countries as the maintenance of an ileal conduit or a catheter is seen to be more difficult.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
procedure where the ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....
s which carry urine from the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s, are diverted into the sigmoid colon
Sigmoid colon
The sigmoid colon is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm...
. It is done as a treatment for bladder cancer
Bladder cancer
Bladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
, where the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
had to be removed. Rarely, the cancer presents in children between the ages of 2 & 10 yrs old as an aggressive rhabdomyosarcoma, although there are diagnoses of children as young as 3 months old. The procedure was also used several decades ago as a correctional procedure for patients born with bladder exstrophy
Bladder exstrophy
Bladder exstrophy is a congenital anomality in which part of the urinary bladder is present outside the body. It is rare, occurring once every 10,000 to 50,000 live births with a 2:1 male:female ratio. The diagnosis involves a spectrum of anomalies of the lower abdominal wall, bladder, anterior...
. In the case of some bladder exstrophy patients, occasional bowel incontinence
Fecal incontinence
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
(in this case, a mixture of urine and feces similar to diarrhea) at night is one uncontrollable consequence.
Another consequence of this procedure is an increased risk of kidney infections (nephritis
Nephritis
Nephritis is inflammation of the nephrons in the kidneys. The word "nephritis" was imported from Latin, which took it from Greek: νεφρίτιδα. The word comes from the Greek νεφρός - nephro- meaning "of the kidney" and -itis meaning "inflammation"....
) due to bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
from faeces travelling back up the ureters (reflux). Patients are commonly put on oral prophylactic antibiotics to combat infections in the uretery tract and the kidneys but this can lead to tolerance of the antibiotic, so over time the patient can build up tolerance to a large number of oral antibiotics, leading to a need for IV (intravenous) antibiotics administered while the patient is an inpatient.
As well as this, the urine entering the colon can cause diarrhea and salt imbalance due to the sodium
Sodium
Sodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...
and chloride
Chloride
The chloride ion is formed when the element chlorine, a halogen, picks up one electron to form an anion Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. The chloride ion, and its salts such as sodium chloride, are very soluble in water...
in the urine. Urea
Urea
Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....
levels in the blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
are higher due to urea crossing the colon wall. In the large intestine
Large intestine
The large intestine is the third-to-last part of the digestive system — — in vertebrate animals. Its function is to absorb water from the remaining indigestible food matter, and then to pass useless waste material from the body...
, sodium is swapped for potassium
Potassium
Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...
, and chloride for bicarbonate
Bicarbonate
In inorganic chemistry, bicarbonate is an intermediate form in the deprotonation of carbonic acid...
, this causes an acidosis
Acidosis
Acidosis is an increased acidity in the blood and other body tissue . If not further qualified, it usually refers to acidity of the blood plasma....
and hypokalaemia. Many patients take sodium bicarbonate to combat this.
Patients with ureterosigmoidostomy have an increased chance of developing carcinoma of the colon after living with the modification for a number of years, on average 20–30 years after the operation, which can also lead to severe surgical adhesions.
This operation is no longer popular in many countries, with an ileal conduit (where the ureters lead into a loop of small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
) being preferred. However, it is still popular in developing countries as the maintenance of an ileal conduit or a catheter is seen to be more difficult.