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Continent Urinary Diversion

Continent Urinary Diversion. Phichaya Sujijantararat 24 October 2003. Continent Urinary Diversion. A system created to collect and store urine before it is removed from the body. Urinary Diversion. Classification:

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Continent Urinary Diversion

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  1. Continent Urinary Diversion Phichaya Sujijantararat 24 October 2003

  2. Continent Urinary Diversion • A system created to collectand store urine before it is removed from the body.

  3. Urinary Diversion Classification: 1. Orthotopic (emptied through urethra ) vs non-orthotopic 2. Continent vs non-continent

  4. Who need it ? 1. Congenital anomalies eg. Exstrophy- Epispadias Complex , Cloacal exstrophy, Bilateral Single Ectopic Ureters 2. Neuropathic bladder 3. Bladder loss eg. Pelvic malignancy 4. Radiation damage 5. Urethral loss

  5. Adult Restoration of previously existing state Child Dawn of the new life Continent Urinary Diversion

  6. Patient selection - ability to self catheterize r/o quadriplegia, multiple sclerosis - highly motivated & intelligence - renal impairment Cr < 1.8 mg% or Ccr > 60 ml/min

  7. Continent Urinary Diversion Three basic components: 1. Reservoir to store urine 2. Continent mechanism to retain urine 3. Channel or tunnel + catheterizable stoma to let the urine out

  8. Continent Urinary Diversion Types of reservoir 1. Native bladder 2. Augmented bladder 3. New constructed pouch or reservoir

  9. Reservoir requirements • Low pressure < 40 cm.H2O ( McGuire 1981 ) • Adequate capacity > 4 hourly emptying

  10. Bowel as a pouch, not a conduit 1. Detubularize to abolish peristalsis 2. Reconfiguration to increase capacity 3. Anti-reflux to prevent renal damage 4. Continence mechanism

  11. The effect of using different lengths of ileal segment

  12. Reconfiguration

  13. Reconfiguration

  14. Continence mechanisms 1. Flap valve eg. Mitrofanoff, Monti 2. Nipple valve eg. Kock nipple 3. Hydraulic valve eg. Benchekroun

  15. Kock Nipple

  16. Bencekroun Hydraulic Valve

  17. Bencekroun Hydraulic Valve

  18. Types of channel or tunnel 1. Appendix 2. Ileum 3. Colon 4. Ureter 5. Fallopian tube

  19. Mitrofanoff

  20. Mitrofanoff

  21. Monti tube (1)

  22. Monti tube (2)

  23. Monti tube (3)

  24. Monti tube (4)

  25. Modified Monti technique

  26. Modified Monti technique

  27. Modified Monti technique

  28. Anti-reflux techniques 1. Flap valve ( submucosal tunnel ) 2. Split cuff nipple 3. Serosal lined extramural tunnel 4. Le Duc ( mucosal trough )

  29. Flap valve principle

  30. Split Cuff Nipple

  31. Le Duc (Mucosal trough)

  32. Anti-reflux techniques

  33. Post-operative care (1) - flush stomal & pouch catheters 2/day - remove ureteric stents on day 7 - leave stomal & pouch catheters for 3 wks - cystogram or pouchogram

  34. Post-operative care (2) - re-admission 6th wk - clamp & release stomal catheter at 2 – 3 hour interval - After the pouch expands to 300-500 ml, remove stomal catheter - start self catheterization - remove pouch catheter

  35. Advantages • No cost for expensive external appliance • Maintain body image • No psychologic impact • Socially acceptable • Maintain sex performance ?

  36. Urogenital sinus

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