1. COMPLICATIONS OF URINARY DIVERSION
GOVINDARAJAN
PG UROLOGY
SRMC

2. 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.

3. 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.

4. 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

5. 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
VOLVULUS

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

7. 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

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

9. METABOLIC COMPLICATIONS
ALTERED SENSORIUM
ALTERED DRUG ABSORPTION
OSTEOMALASIA
INFECTION
ELECTROLYTE ABNORMALITY
STONES
INTESTINAL MOTILITY/SHORT GUT SYN.
CANCER

10. 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

11. 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

12. OSTEOMALACIA ACIDOSIS DEFECT/RESISTANCE TO VIT D
SULFATE METABOLISM ALTERATION
TREATMENT

13. 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

14. 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

15. 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

16. THANK YOU.