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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.

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COMPLICATIONS OF URINARY DIVERSION

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  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 RENAL DETERIORATION VOLVULUS

  6. COMPLICATIONS OF STOMA • SKIN(a.irritativehypo/hyperpigmentation, b.erythematous macular/scaling c.pseudoverrucous wartlike lesions). • STOMAL STENOSIS(ileum 20-24 % ,colon 10-20 % ,). • 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.

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