COMPLICATIONS OF URINARY DIVERSION GOVINDARAJAN PG UROLOGY SRMC

COMPLICATIONS 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 • SEPSIS/INFECTION : wound dehiscence , pelvic abscesses. • 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 • OGILVIE SYNDROME : Usually seen within 3 rd POD. X-RAY abd. When cecum is >12 cm chance of rupture

COMPLICATION RELATED TO THE SEGMENT • STRICTURE TIME OF PRESENTATION ( usually late) ETIOLOGY (exposure to urine/lymphoid depletion / persist. Infection/submucosal fibrosis ) RENAL DETERIORATION • ENLONGATION OF THE SEGMENT Usually distal obstruction is present Increased pressure within the duct RENAL DETERIORATION VOLVULUS

COMPLICATIONS OF STOMA • SKIN(a. irritativehypo/hyperpigmentation, b. erythematous macular/scaling c. pseudoverrucous wartlike lesions). • STOMAL STENOSIS(ileum 20 -24 % , colo 10 -20 % , ). • PARASTOMAL HERNIA end stoma 1 -4% and loop stoma 4 -20%. • BLEEDING FROM VARICES • STOMAL PROLAPSE • STOMAL RETRACTION • STOMAL OBSTRUCTION

COMPLICATION OF URETEROINTESTINAL ANASTAMOSIS • URINARY FISTULA : common 7 -10 days postop, incidence of 3 -9% this can cause periureteric fibrosis & stricture • STRICTURE : more common in antireflux anastomosis(more common in left ureter under IMA) • PYELONEPH : seen early post op and late stage also. Incidence : ileum 12% & colon 13%. • RENAL DETERIORATION : seen in 10 -60%. due to ? anastomosis/intrinsic defect in kidney. . incidence is 18% in ileum & 15% in colon

COMPLICATIONS OF CONDUIT (urine storage) ILEAL CONDUIT BLEEDING HYPERTENSION/RENAL FAILURE OTHERS JEJUNAL CONDUIT MAINLY ELETROLITE ABNORMALITY COLON CONDUIT RENAL FAILURE , DIARROHEA,

METABOLIC COMPLICATIONS 1. 2. 3. 4. 5. 6. 7. 8. ALTERED SENSORIUM ALTERED DRUG ABSORPTION OSTEOMALASIA INFECTION ELECTROLYTE ABNORMALITY STONES INTESTINAL MOTILITY/SHORT GUT SY 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 1000 ml 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 • GROWTH AND DEVELOPMENT • INFECTIONS • STONES : MG, CA, AMM, PHOS seen commonly with hyperghloremic acidosis, pyelonephritic kidney, UTI with urea splitting organism

• THANK YOU.