Urinary diversion
Encyclopedia
Urinary diversion is any one of several surgical procedures to reroute urine
flow from its normal pathway. It may be necessary for diseased or defective ureter
s, bladder
or urethra
, either temporarily or permanently. Some diversions result in a stoma
.
The ureteroenteric anastomosis can be created in a number of different ways. There is the option of a refluxing or a non-refluxing type, and the two ureters can be joined into the intestinal segment either together or separately. The non-refluxing type has been associated with higher incidence of ureteroenteric anastomosis stricture, and there is doubt whether it has any advantages over the refluxing type. Therefore, many surgeons prefer the refluxing type which is simpler and apparently carries a lesser degree of complications.
Refluxing techniques include the Wallace and Wallace II and the Bricker end-to-side anastomosis
. Non-refluxing techniques includes the Le Duc technique.
, neobladder-intestinal and neobladder-cutaneous fistula
s, ureteroenteric anastomosis stricture, neobladder rupture and mucous formation.
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
flow from its normal pathway. It may be necessary for diseased or defective 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, 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...
or urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, either temporarily or permanently. Some diversions result in a stoma
Stoma (medicine)
A stoma is an opening , either natural or surgically created, which connects a portion of the body cavity to the outside environment...
.
Types
- NephrostomyNephrostomyA nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system ....
from the renal pelvisRenal pelvisThe renal pelvis or pyelum is the funnel-like dilated proximal part of the ureter in the kidney.In humans, the renal pelvis is the point of convergence of two or three major calyces... - UrostomyUrostomyA urostomy is a stoma for the urinary system. A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible, e.g...
from more distal origins along the urinary tract, with subtypes including:- Ileal conduit urinary diversionIleal conduit urinary diversionAn ileal conduit urinary diversion is a surgical technique usually referred to as the Bricker ileal conduit after its inventor, Eugene M. Bricker...
(Bricker conduit) - Indiana pouchIndiana pouchAn Indiana pouch is a surgically-created urinary diversion used to create a way for the body to store and eliminate urine for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrophy or who are not continent due to a congenital,...
- Ileal conduit urinary diversion
- Neobladder to urethra diversion
Ureteroenteric anastomosis
A common feature of the three first, and most common, types of urinary diversion is the ureteroenteric anastomosis. This is the joining site of the ureters and the section of intestine used for the diversion.The ureteroenteric anastomosis can be created in a number of different ways. There is the option of a refluxing or a non-refluxing type, and the two ureters can be joined into the intestinal segment either together or separately. The non-refluxing type has been associated with higher incidence of ureteroenteric anastomosis stricture, and there is doubt whether it has any advantages over the refluxing type. Therefore, many surgeons prefer the refluxing type which is simpler and apparently carries a lesser degree of complications.
Refluxing techniques include the Wallace and Wallace II and the Bricker end-to-side anastomosis
Bricker end-to-side anastomosis
The End-to-side anastomosis was used by Eugene M. Bricker in the Bricker conduit urinary diversion, and is still a widely used technique for performing ureteroenteric anastomosis...
. Non-refluxing techniques includes the Le Duc technique.
Complications
Complications include incisional herniaIncisional hernia
An incisional hernia occurs in an area of weakness caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are termed ventral hernias. If it is not caused by an incision, then it is a...
, neobladder-intestinal and neobladder-cutaneous fistula
Fistula
In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...
s, ureteroenteric anastomosis stricture, neobladder rupture and mucous formation.