Render ureterosigmoidostomy for urinary diversion
One of the major problems encountered in urologic patients is the necessity of sidetracting the urine from its normal route. Such diversion may be temporary or permanent, depending upon the disease process for which it is done. Several types of operations are available. One is nephrostomy, and another cutaneous ureterostomy.
These for many years represented the only types of permanent supravesical diversion. While isolated instances of long term successful use of these operations undoubtedly can be cited, in most instances such diversion simply represents substitution of one disease for another, and deterioration of the kidney function from infection and stone formation constitutes the rule. Dissatisfaction with nephrostomy and cutaneous ureterostomy has led to many and varied attempts by other methods. The first of these was ureterosigmoidostomy. Here again the isolated successful cases represent the exception rather than the rule. Recurrent episodes of pyelonephritis and obstruction at the site of anastamosis constitute the late and often lethal complications of this operation.
Within the past decade or so the development of effective methods of sterilization of the bowel and improved techniques of anastamosis have appreciably improved the effectiveness of this form of diversion. Even so, consistent absence of infection has rarely been achieved and the additional complications of electrolyte imbalance from reabsorption of the chloride ion from the bowel, coupled with the loss of potassium resulting in the so called hypochloremic acidosis has emerged as a complicating factor in long term follow up.
This complication is less likely to occur when the upper urinary tract is normal at the time of the ureterosigmoidostomy. Even when it develops, prophylactic and remedial measures consisting of frequent evacuation of the bowel, and administration of alkalies by mouth, render ureterosigmoidostomy acceptable in certain eases.
When the operation is successful it has the desirable feature of not requiring any external collecting device. In my own experience I have achieved some highly acceptable results. In exstrophy this is still the preferred method of treatment. There seems to be some inherent ability of the young to adapt to this essentially unphysiologic operation.
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