W4L4 Urinary Diversion

Question 1

Def?

Answer 1

Storage of urine in reservoir other than bladder/passage of urine in pathway other than normal urethra

Question 2

Indi urinary diversion

Answer 2

1- Absent bladder: ectopia vesica
2- Useless bladder: neuropathic bladder, severe trauma
3- Dangerous bladder: bladder cancer

Question 3

Type diversion?

Answer 3

1. Non-continent
   - Ileal loop conduit
2. Continent
   
   • Orthotropic(Ileal w neobladder)
   • Cutaneous(Ileocecal pouch)
   • Rectal(Ureterosigmoidostomy)

Question 4

What are the criteria of ideal pouch?

Answer 4

1-Adquate capacity
2-Continent
3- Non-refluxing
4-Low pressure
5- Non-absorptive

Question 5

Orthotopic diversions

Answer 5

❖ Ileal neobladders
- Urethral Kock Pouch 
- Ileal W-neobladder
- T pouch
❖Colonic neobladder: 
- Ascending colon
- Sigmoid colon
❖Ileo-colonic neobladder: 
- Mainz pouch
- Le Bag pouch

Question 6

Continent cutaneous diversion

Answer 6

➢Ileal reservoirs 
- Koch pouch
- Double T pouch
➢Ileo-colonic reservoirs 
- Indiana pouch
- Mainz II pouch
➢Gastric reservoirs

Question 7

Anal sphincter controlled

Answer 7

1. Without faecal exclusion:
   - Uretero-sigmoidostomy
2. With faecal exclusion:
   -Simple rectal bladder
3. Functional exclusion:
   Augmented valved rectum with :
   - Hemi-kock - T pouch

Question 8

Choice of urinary diversion

Answer 8

➢Patient’s factor
-age,gender,life style, obese
➢Urinary tract factors 
-SCr>1.6mg/dl, creatinine clearance <50 
➢Oncological factors 
-histopathological, tumor stage, urethral
➢Bowel segment factors 
-sbs,irradiation,surgery
➢Others

Question 9

Early complication?

Answer 9

A) Pouch-related:
-Urinary leakage
-Pelvic collection
B) Pouch-unrelated:
-Intestinal obstruction 
-Intestinal fistula 
-Infection

Question 10

Non- metabolic Late complications?

Answer 10

1. Inlet-related:
   -Stricture uretero-ileal anastomosis -Reflux
2. Pouch-related:
   -Stone -Rupture -UTI
   3- Outlet-related:
   -Retention -Para-stomal hernia

Question 11

Metabolic Late complications?

Answer 11

1- Electrolytes disturbance
2- Bone abnormalities (osteomalacia) 3- Nutritional deficiency
4- Altered sensorium
5- Abnormal drug metabolism
6- Carcinogenesis
7- Renal function deterioration
8- Altered growth & development

Question 12

Electrolytes abnormalities

Answer 12

1. Stomach(Loss of HCL)
   - Hypo-chloremic metabolic alkalosis
2. Ileum and colon(Gain NH4 CL)
   - Hyper-chloremic metabolic acidosis