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We present a case of cutaneous zygomycosis in a patient with an ureteroileostomy and severe metabolic acidosis, but without diabetes. The patient died despite multiple aggressive surgical interventions and antifungal therapy with liposomal amphotericin B. Ureteroileostomy-related acidosis can be a predisposing factor for zygomycosis. Metabolic acidosis can have a role in the severity of cutaneous disease.

Trabajo fin de grado. Defendido en junio de 2015. España es el país de la Unión Europea con mayor incidencia de cáncer vesical. En estadios avanzados el tratamiento de elección es la realización de una cistectomía radical con linfadenectomía. La técnica quirúrgica más frecuente es la ureteroileostomía tipo Bricker. Se trata de una derivación urinaria no continente que conlleva la realización de una urostomía. Los pacientes se sienten abrumados ante esta nueva situación y el personal de enfermería es clave indispensable en la recuperación del paciente debido a su posición a pie de cama. Ante la escasez y variabilidad encontrada en la bibliografía sobre los cuidados de enfermería tras esta intervención hasta el alta, este trabajo propone un plan de cuidados estandarizado de aplicación en unidades hospitalarias de urología, favoreciendo la continuidad de cuidados y tratando de disminuir la variabilidad asistencial. Abstract: Spain is the country of the European Union which has the higher incidence of bladder cancer. In advanced stages the treatment of choice is the realization of a radical cystectomy with lymphadenectomy. The most common surgical technique is ureteroileostomy type Bricker. This is a non-continent urinary diversion that involves performing a urostomy. Patients feel overwhelmed by this new situation and the nursing staff is essential in patient recovery due to its position at bedside. Given the scarcity and variability found in the literature on nursing care after this intervention until hospital discharge, this paper proposes a standardized care plan for implementing in urology hospital units, promoting continuity of care and trying to reduce variability of care. Ordenador con navegador de Internet; Adobe Acrobat Reader 33 p. (Según el contador de la aplicación)

We demonstrated a new operative technique for antireflux ureteroileostomy in dogs. The severed ureter was reimplanted into the isolated ileum. Ten terminal ureters were covered with a 2 x 2 cm2 section of de-serosalized ileal wall after direct ureteroileostomy, and another six terminal ureters were covered with a 2 x 2 cm2 section of non-de-serosalized full-thickness ileal wall. Thirteen ureters were directly anastomosed to the ileum without any additional procedures. The bladder was augmented by the detubularized ileum with the ureter. Postoperative evaluations on ureteral stenosis and reflux were performed monthly for 3 months. The ureters covered with the de-serosalized ileal wall prevented ureteral reflux even when the intravesical pressure climbed as high as 100 cm H2O. Although two of these ten ureters demonstrated strictures at the precise site of direct ureteroileostomy, the sections of the ureters covered with the de-serosalized ileal wall were opened and did not collapse. In the resected specimens, the terminal ureters were found in the intramural part of the ileum. The ureters covered with the full-thickness of ileal wall did not prevent reflux. Our method of covering the terminal ureter with the de-serosalized ileal wall worked well as an antireflux mechanism, and the intramural ureter did not cause ureteral stricture. After this animal experiment, we introduced this antireflux mechanism clinically.

Resumen Objetivo OBJETIVOS: Analizar las alteraciones encontradas en la mucosa de ileon terminal en contacto con orina en pacientes con ureteroileostomia cutanea tras cistectomia por carcinoma vesical infiltrante. Material y metodos Se han practicado 21 biopsias de mucosa intestinal a otros tantos pacientes. Se han determinado longitud de vellosidades intestinales (valores normales -VN-: 350 - 300 μ), longitud de criptas (V.N.: 70-100 μ), cociente cripta/vellosidad (VN: 0,2), relacion celulas caliciformes/enterocitos, existencia de linfangiectasias e infiltrado inflamatorio. Se determinaron igualmente la existencia de alteraciones analiticas mediante ionograma y gasometria venosa. Resultados La edad media de los pacientes fue 65,2 anos ± 7,4 DE. El 66,7% fueron varones. El tiempo de evolucion con la derivacion urinaria ha sido 59,5 meses ± 53,2 DE. La longitud media de las vellosidades fue de 178,2 μ ± 70,2 DE, la longitud media de las criptas fue 290,9 μ ± 114,4 DE y el cociente medio cripta/vellosidad de 4,2 ± 9,2 DE. El 57,1% presento un infiltrado inflamatorio submucoso leve, un 23,8% moderado y un 19,0% intenso. Unicamente en 2 casos se detectaron imagenes de linfangiectasia. El coeficiente celulas caliciformes/enterocitos fue de 3,3 ± 1,3 DE. No se objetivo correlacion entre el tiempo de evolucion de la derivacion urinaria con las distintas alteraciones en mucosa intestinal ni relacion entre el grado de atrofia de mucosa con la existencia de alteraciones metabolicas. Conclusiones Las alteraciones de la mucosa del ileon terminal en pacientes con derivacion urinaria tipo ureteroileostomia cutanea se caracterizan por una atrofia marcada de vellosidades intestinales con aumento de la longitud de criptas, aumento del cociente cripta/vellosidad y la presencia de infiltrado inflamatorio entre leve y moderado fundamentalmente. Existe tambien un aumento de celulas caliciformes en detrimento de enterocitos. Todos estos cambios son independientes del tiempo de evolucion de los pacientes con su derivacion urinaria.

Fifty-eight patients representing one hundred fourteen renal units with myelodysplasia who have undergone urinary diversion by cutaneous ureteroileostomy were studied. Postoperative complications, radiologic findings, and the incidence of urinary tract infection are presented. The value of the conjoined technic of ureteroileal implantation as compared to the standard Bricker technic is discussed. The conjoined technic has yielded a decreased rate of postoperative complications in our patients.

We have used the continent ileal bladder as a bladder replacement after radical cystectomy. The ileal bladder is an ileal pouch which is anastomosed to the urethral stumps. The ureters are implanted by a free end ureteroileostomy. The long term results with 26 patients who underwent this procedure are reported. In the early postoperative period, urodynamic and radiographic studies revealed small capacity and high intravesical pressure of the ileal bladder. However, it became a low pressure reservoir with increased capacity gradually. The average bladder capacity was about 250 ml and average residual urine was 30 ml. Most of the patients were continent in the daytime if the voiding intervals were less than 3 hours at night, some patients were incontinent. Urinary leakage was the most frequent complication. VUR and hydronephrosis were still the problems to be solved. The ileal pouch bladder is a valuable procedure in properly selected cases.

Two cases are reported showing development of deformities identical with rickets in patients with ureterosigmoidostomies.The basic mechanism involved is believed to be hyperchloremic acidosis.The condition was ameliorated under alkali therapy and substitution of ureteroileostomy for ureterosigmoidostomy.

Five patients have received renal homografts with urinary drainage into ileal conduits since March 1970. The renal vessels were anastomosed end-to-side into the terminal vena cava and aorta. The ureter, in its normal dependent position, entered a short ileal segment. The only complication in the series was a parastomal hernia developing thirty-three months after the transplant. We believe this technique offers several advantages over those previously described.

A review is presented of 39 patients with spinal cord injury who were diverted by ureteroileostomy. Because of a significant complication rate and the fact that some normal renal units may deteriorate, the procedure is reserved for the patient with irreversible upper tract changes that fail to respond to more conservative management.

SUMMARY External urinary diversion by the method of pyelo-colostomy has been performed in 8 children. It is suggested that this procedure may give better long-term results than cutaneous ureteroileostomy when the ureters are dilated and of poor contractility.

A technique is described by which calculi can be removed from the distal ureters of patients with ileal conduit urinary diversions. A percutaneous nephrostomy is done and an angiogram catheter is manipulated down the ureter past the obstruction. After the angiogram catheter is retrieved from the loop with a Bumpus forceps a stone basket is attached, pulled up the ureter and opened. The stone can then be captured under fluoroscopic control and, by replacing the stone basket with a silicone splint, the ureteroileostomy also can be splinted. This may be important particularly if there is extravasation from the ureteroileostomy after stone manipulation or operation.

We report on 3 patients with spontaneous diversion of the urine to the bowel from functioning ureteroileostomy after cystoprostatectomy. Management of these complications has resulted in no serious problem and a conservative approach to this infrequent development is recommended.

A modified technique of Bricker's ureteroileostomy was described for safe urinary reconstruction after pelvic exenteration. It consists of ureteral anastomosis to the mesenteric side of the ileal segment, so the anastomosis as well as the distal ureter is buried in the mesentery. There was no anastomotic leakage, obstructive uropathy, or clinically overt pyelonephritis in six consecutive patients.

Percutaneous placement of ureteral stents is advocated as an attractive alternative to surgical procedures in the management of some ureteral dehiscence, strictures, and inflammatory ureteral fistulae. In 50 patients with partial dehiscence or fistulae, a stent could be placed percutaneously in 41. The method achieved a salvage rate of renal function (30 cases [60%]) similar to that of open surgical correction. Hospitalization time and costs, however, were far less. The method proved particularly successful (nine of 10 cases) for correction of pelvic ureters severed from the bladder during pelvic surgery, dehiscence of ureteroneocystostomies into boari flaps, and traumatic severance of the upper and mid ureters. The method is also highly recommended for the management of strictures occurring at ureteroileostomy sites and at the ureteroneocystostomy site of cadaver transplant kidneys. Although the ultimate salvage of renal function is lower than in the above-described conditions, the relative ease of placing percutaneous stent catheters across such strictures in comparison with highly complex surgical salvage procedures necessary to correct these conditions makes the former the first choice.

THE multiplicity of surgical procedures proposed1 to divert the urinary stream after total cystectomy shows that there has been no satisfactory solution to the major problems of obstruction, infection and hyperchloremic acidosis. Nephrostomy and cutaneous ureterostomy are not usually efficacious because they require intubation, which almost always leads to progressive pyelonephritis. In 1911 Coffey2 advocated tunneling of the ureter through the sigmoid wall to prevent reflux of bowel contents. Stricture of the anastomosis tended to occur, leading to obstruction and ascending infection. A long-term follow-up study on 144 ureterosigmoidostomies of this type for exstrophy of the bladder3 at the Mayo . . .

The value of ureteroileostomy as an eminently satisfactory method for urinary diversion is attested to by the ever-increasing number of reports of its application to large numbers of patients. The indications, techniques, and complications of the operation have also been well documented(1–3). Included in these various discussions have been references to stomal difficulties and their management(4). In general, however, very little attention has been given to those infrequent situations in which actual replacement or relocation of the stomal site has been deemed necessary. In our own series this has been carried out in a small group of patients depending upon etiological factors, antecedent surgery, and underlying patient constitution.

URINARY diversion is essential for the management of certain urologic disorders of childhood. Implantation of the ureters into an isolated segment of ileum, with restoration of intestinal continuity, has found wide application since it was popularized by Bricker1 in 1950. Most reports2 3 4 5 6 have referred primarily to the ileal conduit in adults as a method of urinary diversion associated with the treatment of pelvic cancer. The nature of such underlying diseases and their complications has limited evaluation of the long-term effects of the ileal conduit procedure per se. In children, diversion is most often done for benign diseases involving urinary-tract dysfunction, . . .

Summary Thirty-seven patients with carcinoma of the urinary bladder underwent cystectomy and ureteroileostomy between 1957 and 1968. Thirty-one patients recovered and were followed up postoperatively. Seven of sixteen patients (44 per cent) operated upon more than five years ago have survived. The chance for survival appeared related to the invasiveness of the tumor. In the absence of recurrent tumor, ureteroileal conduits have functioned well. The results obtained are comparable to those reported by institutions specializing in the treatment of cancer and add support to the performance of total cystectomy and ureteroileostomy earlier in the management of invasive vesical carcinoma, before lesions become more deeply infiltrating and the chance of cure is diminished.

SUMMARY Twenty-five cases treated for a variety of lower urinary tract conditions by the operation of ureteroileostomy have been studied by retrograde ileography, and the dynamics of the conduits and incidence of ureteric reflux from them analysed, to determine the effects of reflux on the status of the related kidneys and the occurrence of urinary infection. Although no relationship was demonstrated between infection and the occurrence of reflux, there appeared to be some improvement in the quality of renal function as demonstrated by intravenous urography in those cases in whom reflux had been prevented.

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

IN 1935, Seiffert 1 reported in a German surgical journal a procedure of bilateral ureteral transplantation into a segment of intestine as a method of supravesical urinary diversion. It remained, however, for Eugene Bricker, MD, 15 years later to modify and popularize the procedure which we now know as the ileal loop. 2 The ileal loop was presented originally as a relatively simple method of urinary diversion which hopefully would overcome the many pitfalls of nephrostomies, cutaneous ureterostomies, and ureterosigmoidostomies. Since 1950, this method has been widely used to treat a large variety of urologic and surgical conditions requiring urinary diversion. Reports have appeared in the literature at intervals outlining the experience of groups or individuals with this operation and containing various modifications to the original procedure. The present study, comprising 120 cases, reports the 10 year experience with ileal loop diversion in the University Hospitals of Cleveland and its