Ileal conduit urinary diversion
Encyclopedia
An ileal conduit urinary diversion is a surgical technique usually referred to as the Bricker ileal conduit after its inventor, Eugene M. Bricker. It is a form of urostomy
, and was developed during the 1940s and is still one of the most used techniques for the diversion of urine after a patient has had their bladder removed, due to its low complication rate and high patient satisfaction level. It is usually used in conjunction with radical cystectomy
in order to control invasive bladder cancer.
To create an ileal conduit, the ureter
s are surgically resected from the bladder and a ureteroenteric anastomosis is made in order to drain the urine into a detached section of ileum
(a part of the small intestine
). The end of the ileum is then brought out through an opening (a stoma
) in the abdominal wall. The urine is collected through a bag that attaches on the outside of the body over the stoma. The bag must be periodically emptied of urine, and must be replaced every one or two days. Any period longer than this poses the risk of infection.
Another and very effective use of an ileal conduit is for systemic isolation of a kidney transplant, often due to bladder nephropathy that may pose an unacceptable risk of reflux and thus infection or obstruction, into the transplanted organ. The urostomy is fashioned as previously described and connected ureteroenteric anastomosis to the transplant ureter. Urinary tract infections are unfortunately very common because stomas are natural colonisers of bacteria; in transplant patients, antibiotic treatment, often over a long term and more frequent appliance changes are effective but not curative countermeasures.
The bag adheres to the skin using a disk made of flexible, adherent materials. Unfortunately, there can be problems with leaking and rashes (excoriation), and heavy physical exertion will exacerbate deterioration of the appliance. Sometimes the leakage occurs unexpectedly, and "ostomates" (as they are known) usually carry a spare appliance to deal with unexpected emergencies.
Urostomy
A urostomy is a stoma for the urinary system. A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible, e.g...
, and was developed during the 1940s and is still one of the most used techniques for the diversion of urine after a patient has had their bladder removed, due to its low complication rate and high patient satisfaction level. It is usually used in conjunction with radical cystectomy
Cystectomy
Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst, or the gallbladder. The most common condition warranting removal of the urinary bladder is bladder cancer. After the bladder has been removed, an...
in order to control invasive bladder cancer.
To create an ileal conduit, the ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....
s are surgically resected from the bladder and a ureteroenteric anastomosis is made in order to drain the urine into a detached section of ileum
Ileum
The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
(a part of the small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
). The end of the ileum is then brought out through an opening (a stoma
Stoma (medicine)
A stoma is an opening , either natural or surgically created, which connects a portion of the body cavity to the outside environment...
) in the abdominal wall. The urine is collected through a bag that attaches on the outside of the body over the stoma. The bag must be periodically emptied of urine, and must be replaced every one or two days. Any period longer than this poses the risk of infection.
Another and very effective use of an ileal conduit is for systemic isolation of a kidney transplant, often due to bladder nephropathy that may pose an unacceptable risk of reflux and thus infection or obstruction, into the transplanted organ. The urostomy is fashioned as previously described and connected ureteroenteric anastomosis to the transplant ureter. Urinary tract infections are unfortunately very common because stomas are natural colonisers of bacteria; in transplant patients, antibiotic treatment, often over a long term and more frequent appliance changes are effective but not curative countermeasures.
The bag adheres to the skin using a disk made of flexible, adherent materials. Unfortunately, there can be problems with leaking and rashes (excoriation), and heavy physical exertion will exacerbate deterioration of the appliance. Sometimes the leakage occurs unexpectedly, and "ostomates" (as they are known) usually carry a spare appliance to deal with unexpected emergencies.