Permanent diversion of the urinary stream is essential in the definitive treatment of many afflictions. These include diseases requiring total cystectomy, lesions causing urinary incontinence which cannot be treated by attacking the affected organ (e. g., myelomeningocele), and diseases in which the bladder has become so altered it cannot function in a manner that allows comfort for the patient (e. g., postradiation cystitis, severely contracted bladder).
The methods of urinary diversion commonly used have left much to be desired. Ureterocutaneous anastomoses usually require indwelling catheters for optimum drainage of the renal pelves. Infection of the kidneys is therefore frequent, and the organism is usually a urea-splitter, which causes the urine to become strongly alkaline. Since the solubility of calcium is thus decreased, calcific concretions form upon the catheters and renal stones are therefore common. If catheters are not employed, the ureterocutaneous stomas may become stenosed.
Nephrostomy affords more efficient drainage
SMITH DR, WHITROCK RM, GOULD ES, RUTNER A. Ureteroileostomy: An Experimental and Clinical Evaluation. AMA Arch Surg. 1956;72(6):915–924. doi:10.1001/archsurg.1956.01270240027005
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