Documente Academic
Documente Profesional
Documente Cultură
OF URINARY
DIVERSION
GOVINDARAJAN
PG UROLOGY
SRMC
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.
COMPLICATION IN GEN.
(AS WITH ANY INTESTINAL SURGERY)
• FISTULA : urinary / fecal.USUALLY SEEN
WITHIN FIRST FEW WEEKS POSTOP
• OBSTRUCTION :
Incidence: 10% FOR ILEUM/STOMACH AND
5% FOR COLON
Causes ADHERSION,RECURENCE OF
MALIGNANCY,VOLVULUS,INTERNAL
HERNIA,STENOSIS,OBSTRUCTION AT
ANASTOMOTIC LINE.
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
ILEAL CONDUIT
BLEEDING
HYPERTENSION/RENAL FAILURE
OTHERS
JEJUNAL CONDUIT
MAINLY ELETROLITE ABNORMALITY
COLON CONDUIT
RENAL FAILURE , DIARROHEA,
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
ELECTROLYTE ABNORMALITY
STOMACH: HYPOCHLOREMIC HYPOKALEMIC
ALKALOSIS
PROBLEM IN CRF…………..
TREATMENT
JEJUNUM : HYPONATREMIC HYPOCHLOREMIC
HYPERKALEMIC ACIDOSIS
DEHYDRATION……RENIN/ALDOSTERONE
ILEUM & COLON :HYPERCHLOREMIC ACIDOSIS
URETEROSIGMOID :DIARROHEA,HYPOKALEMIA
DUE TO CRF/OSMOTIC DIURESIS/INTEST.
SECRETION /POOR REABSORPSION BY COLON
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
OSTEOMALACIA
• ACIDOSIS
• DEFECT/RESISTANCE TO VIT D
• SULFATE METABOLISM ALTERATION
TREATMENT
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
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
OTHERS…………
• ABNORMAL DRUG METABOLISM
• INFECTIONS
• STONES : MG,CA,AMM,PHOS
seen commonly with
hyperghloremic acidosis,pyelonephritic
kidney,UTI with urea splitting organism
• THANK YOU.