Urinary diversion is any one of several
surgical procedure
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
s to reroute
urine flow from its normal pathway. It may be necessary for diseased or defective
ureters,
bladder or
urethra, either temporarily or permanently. Some diversions result in a
stoma
In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...
.
Types
*
Nephrostomy from the
renal pelvis
The renal pelvis or pelvis of the kidney is the funnel-like dilated part of the ureter in the kidney. It is formed by the covnvergence of the major calyces, acting as a funnel for urine flowing from the major calyces to the ureter. It has a mucous ...
*
Urostomy from more distal origins along the urinary tract, with subtypes including:
**
Ileal conduit urinary diversion (Bricker conduit)
**
Indiana pouch
*
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. Non-refluxing techniques includes the Le Duc technique.
Complications
Complications include
incisional hernia, neobladder-intestinal and neobladder-cutaneous
fistulas,
ureteroenteric anastomosis stricture, neobladder rupture and mucous formation. Ureteral diversion can lead to
normal anion gap acidosis.
See also
*
Surgical anastomosis
A surgical anastomosis is a surgical technique used to make a new connection between two body structures that carry fluid, such as blood vessels or bowel. For example, an arterial anastomosis is used in vascular bypass and a colonic anastomosis i ...
References
*
*
External links
eMedicine: Urinary Diversions and Neobladders
{{Urologic surgical and other procedures
Urologic surgery