Renal complications following ureteral diversion
- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
Urinary diversion is a surgical procedure in which the normal flow of urine out of the body is rerouted away from the bladder. This procedure is most commonly performed following cystectomy due to medically refractory invasive bladder cancer . Other indications for cystectomy include neurogenic bladder disease due to spinal cord lesions, urinary incontinence, vesicovaginal fistulae, scarring due to infection or chemotherapy, and failed reconstruction after congenital anomalies .
There are three major forms of urinary diversion performed in patients requiring a cystectomy (see "Urinary diversion and reconstruction following cystectomy" and "Radical cystectomy and bladder-sparing treatments for urothelial bladder cancer" and "Laparoscopic/robotic-assisted radical cystectomy"):
●Ileal conduit – A non-continent cutaneous diversion in which the urine flows from the ureters through a segment of bowel (usually ileum, termed ileal conduit) to the skin surface as a stoma, where it is collected in an external bag or other appliance.
●Continent cutaneous diversion – A cutaneous continent reservoir may be constructed to avoid the need for an external appliance (usually using the right colon and terminal ileum). The patient self-catheterizes him- or herself at regular intervals to empty the reservoir.
●Orthotopic neobladder – For men and women wishing to avoid cutaneous urinary diversion, an orthotopic neobladder may be formed from a segment of bowel and attached to the urethra, enabling them to void through the urethra. Continent diversions can greatly improve patient quality of life and self-image and can increase his or her acceptance of radical cystectomy.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Lee RK, Abol-Enein H, Artibani W, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 2014; 113:11.
- Stein R, Schröder A, Thüroff JW. Bladder augmentation and urinary diversion in patients with neurogenic bladder: surgical considerations. J Pediatr Urol 2012; 8:153.
- Kristjánsson A, Wallin L, Månsson W. Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 1. Glomerular filtration rate and patency of uretero-intestinal anastomosis. Br J Urol 1995; 76:539.
- Yossepowitch O, Baniel J. Ureterosigmoidostomy and obstructive uropathy. Nat Clin Pract Urol 2005; 2:511.
- McDougal WS. Metabolic complications of urinary intestinal diversion. J Urol 1992; 147:1199.
- Cruz DN, Huot SJ. Metabolic complications of urinary diversions: an overview. Am J Med 1997; 102:477.
- Mundy AR. Metabolic complications of urinary diversion. Lancet 1999; 353:1813.
- Tanrikut C, McDougal WS. Acid-base and electrolyte disorders after urinary diversion. World J Urol 2004; 22:168.
- Koch MO, McDougal WS. The pathophysiology of hyperchloremic metabolic acidosis after urinary diversion through intestinal segments. Surgery 1985; 98:561.
- Agarwal R, Afzalpurkar R, Fordtran JS. Pathophysiology of potassium absorption and secretion by the human intestine. Gastroenterology 1994; 107:548.
- Aronson PS, Giebisch G. Effects of pH on potassium: new explanations for old observations. J Am Soc Nephrol 2011; 22:1981.
- Wang T, Egbert AL Jr, Aronson PS, Giebisch G. Effect of metabolic acidosis on NaCl transport in the proximal tubule. Am J Physiol 1998; 274:F1015.
- Kaveggia FF, Thompson JS, Schafer EC, et al. Hyperammonemic encephalopathy in urinary diversion with urea-splitting urinary tract infection. Arch Intern Med 1990; 150:2389.
- Eskandar N, Holley JL. Hyperkalaemia as a complication of ureteroileostomy: a case report and literature review. Nephrol Dial Transplant 2008; 23:2081.
- Mingin GC, Stock JA, Hanna MK. Gastrocystoplasty: long-term complications in 22 patients. J Urol 1999; 162:1122.
- Renaud CJ, Ng WP. Conventional bicarbonate haemodialysis in postgastrocystoplasty metabolic alkalosis. Singapore Med J 2008; 49:e121.
- Castellan M, Gosalbez R, Perez-Brayfield M, et al. Tumor in bladder reservoir after gastrocystoplasty. J Urol 2007; 178:1771.
- Cohen TD, Streem SB, Lammert G. Long-term incidence and risks for recurrent stones following contemporary management of upper tract calculi in patients with a urinary diversion. J Urol 1996; 155:62.