Transcript COMPLICATIONS OF URINARY DIVERSION

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 3rd
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 SYN
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
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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.