Bladder Reconstruction
What are 4 types of bowel segments utilized in urinary diversion?
Stomach, Jejunum, Ileum, Colon.
Where do you excise in the ureter (clock) for endopyelotomy.
Bonus: What is the initial success rate?
Full thickness incision through the lateral/posterolateral aspect of the ureter.
53-94% success rate initially. Questionable long term success.
What is the continent mechanism made from in an Indiana pouch?
Ileocecal valve
What are the two types of ureteroenteric anastomoses?
Bricker, Wallace
In an appropriately hydrated patient, what T1/2 indicates NO obstruction?
<10 minutes
Stricture at the ureterostomy site
What are the possible advantages of intracorporeal diversion?
Decreased readmission rates, peri-op transfusion, and shorter length of stay
Aperistaltic ureteral segment, intrinsic stenosis, ureteral valves, lower pole accessory crossing vessel, high ureteral insertion with kinks, adhesive bands
What are the indications for Ureterocalycostomy in UPJ reconstruction?
1. small intra-renal pelvis
2. Horshoe kidney to ensure gravity dependent drainage
3. As a salvage procedure
What are the 5 most common surgical complications of urinary diversion?
Bowel obstruction, bowel leak, urine leak, uretero-enteric anastomotic stricture, parastomal hernia
Name 3 advantages of PCN placement while evaluating a clinically obstructed patient for UPJO
1. Can perform antegrade studies
2. Can cap trial
3. Ureteral rest prior to UPJ reconstruction
What are 3 salvage procedures after failed pyeloplasty?
1. Re-do pyeloplasty
2. buccal graft pyeloplasty
3. endopyelotomy
What colonic segment is preferred for conduit creation in patients with a history of pelvic radiation?
Transverse colon
What are the indications for endopyelotomy?
1. renal function greater than 30%
2. Stenotic segment less than 1.5cm length
3. Absence of a crossing vessel causing obstruction
4. Absence of significant nephrolithiasis
What metabolic acidosis are patients with a colon/ileal conduit urinary diversion at risk for?
Hyperchloremic, hypokalemic metabolic acidosis