Our Summary

The study discusses the process of urinary diversion (UD), a surgical operation that reroutes urine flow from its typical path by using a piece of the intestine. This procedure has several potential short and long-term risks. However, with modern methods of documenting these issues, our understanding of how frequently and severely they occur has improved. To decrease early complications after surgery, the research suggests using improved recovery methods, limiting the amount of fluid used during surgery, and referring patients to medical centers that regularly perform these operations. The study also finds that the risk of complications increases over time after the UD procedure. These complications can include issues with the surgical join between the ureter and intestine, the formation of kidney stones, and problems with the surgical opening (stoma). The paper emphasizes the importance of regular check-ups for patients who have undergone UD, to keep an eye on potential complications related to body structure, infections, and metabolism. Surgeons who carry out UD procedures should be aware of the risks and timing of potential post-surgery complications.

FAQs

  1. What are the short- and long-term complications of urinary diversion surgery?
  2. What methods are used to minimize early postoperative complications after urinary diversion surgery?
  3. What kind of complications require close surveillance in patients with urinary diversions?

Doctor’s Tip

A helpful tip a doctor might tell a patient about urinary diversion surgery is to closely follow their recommended postoperative care plan, including regular follow-up appointments and surveillance to monitor for any potential complications. It is also important to maintain good hydration, practice proper hygiene, and report any symptoms or concerns to their healthcare provider promptly. Additionally, they should consider seeking care from a high-volume center with experience in performing urinary diversion surgeries to help minimize the risk of complications.

Suitable For

Patients who may be recommended for urinary diversion surgery include those with:

  • Bladder cancer requiring radical cystectomy
  • Neurogenic bladder dysfunction
  • Severe interstitial cystitis
  • Radiation cystitis
  • Traumatic bladder injury
  • Congenital anomalies affecting the bladder
  • Intractable urinary incontinence
  • Recurrent urinary tract infections
  • Bladder dysfunction due to previous surgeries or other medical conditions

These patients may benefit from urinary diversion surgery to improve their quality of life and manage their underlying condition. It is important for healthcare providers to carefully evaluate each patient’s individual situation and medical history to determine if urinary diversion surgery is the most appropriate treatment option.

Timeline

Before urinary diversion surgery:

  • Patient undergoes a thorough evaluation by a urologist to determine the need for urinary diversion surgery
  • Patient may undergo preoperative testing such as blood tests, imaging studies, and urodynamic testing
  • Patient receives counseling on the different types of urinary diversion surgeries and their potential risks and benefits
  • Patient undergoes surgical preparation and anesthesia consultation before the procedure

After urinary diversion surgery:

  • Immediate postoperative period: Patient is closely monitored in the recovery room for any signs of complications such as bleeding, infection, or urinary leakage
  • Patient may experience pain, nausea, and difficulty with bowel function in the days following surgery
  • Patient may require a catheter or ostomy bag to manage urine output in the immediate postoperative period
  • Patient is discharged from the hospital once stable and may require follow-up appointments with their surgeon to monitor for complications and ensure proper healing
  • Long-term follow-up: Patient may experience complications such as ureterointestinal anastomotic strictures, urolithiasis, and stomal issues in the months and years following surgery
  • Patient requires close surveillance to monitor for anatomic, infectious, and metabolic complications and may require additional interventions or surgeries to manage these complications.

What to Ask Your Doctor

  1. What are the potential short-term complications of urinary diversion surgery?
  2. How can I minimize the risk of early postoperative complications?
  3. What are the long-term complications associated with urinary diversion surgery?
  4. How often will I need to be monitored for complications after the surgery?
  5. What symptoms should I watch for that may indicate a complication?
  6. Are there any lifestyle changes I should make to reduce my risk of complications?
  7. What is the likelihood of developing ureterointestinal anastomotic strictures, urolithiasis, or stomal issues after the surgery?
  8. How often should I have follow-up appointments to monitor for complications?
  9. Are there any specific warning signs that I should be aware of that may indicate a complication?
  10. Should I consider seeking care from a high-volume center for this surgery to reduce my risk of complications?

Reference

Authors: Anderson CB, McKiernan JM. Journal: Urol Clin North Am. 2018 Feb;45(1):79-90. doi: 10.1016/j.ucl.2017.09.008. PMID: 29169453