Presentation is loading. Please wait.

Presentation is loading. Please wait.

COMPLICATIONS OF URINARY DIVERSION GOVINDARAJAN PG UROLOGY SRMC.

Similar presentations


Presentation on theme: "COMPLICATIONS OF URINARY DIVERSION GOVINDARAJAN PG UROLOGY SRMC."— Presentation transcript:

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 3 rd 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 %,colon %,). 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 1.ALTERED SENSORIUM 2.ALTERED DRUG ABSORPTION 3.OSTEOMALASIA 4.INFECTION 5.ELECTROLYTE ABNORMALITY 6.STONES 7.INTESTINAL MOTILITY/SHORT GUT SYN. 8.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.


Download ppt "COMPLICATIONS OF URINARY DIVERSION GOVINDARAJAN PG UROLOGY SRMC."

Similar presentations


Ads by Google