Editing Intestinal Segments and Urinary Diversion (section)

==== <span style="color:#0000ff">R</span><span style="color:#ff0000">enal function deterioration ====
* '''≈20% of patients experience significant and progressive renal function deterioration independent of the type of urinary diversion'''
** '''Incidence for both sepsis and renal failure are greater in patients with ureterosigmoidostomy than in those with conduits'''
*** '''Most common cause of death in patients with ureterosigmoidostomy for > 15 years is acquired renal disease'''
* '''Renal function necessary for urinary intestinal diversion'''
** The amount of renal function required to effectively blunt the reabsorption of urinary solutes by the intestinal segment and to prevent serious metabolic side effects '''depends on the type of urinary intestinal diversion constructed (i.e., the amount of bowel to be used and the length of time the urine is exposed to the intestinal mucosa).'''
*** '''A greater degree of renal function is necessary for continent diversions than for short conduit diversions.'''
** '''eGFR cut-off for continent diversion''' varies by source:
*** Chapter 97: > 40ml/min
*** Chapter 99: >35 – 40 mL/min
*** '''2019 AUA MIBC Guidelines: > 45 mL/min'''
**** '''A patient with serum creatinine > 2 mg/dL (177 µmol/L) may be considered for a continent diversion if:'''
****# '''Able to achieve a urine ≤ pH of 5.8 after an ammonium chloride load'''
****# '''Able to achieve urine osmolality ≥ 600 mOsm/kg in response to water deprivation'''
****# '''GFR > 35 mL/min'''
****# '''Minimal protein in the urine'''
* '''Because urea and creatinine are reabsorbed by both the ileum and the colon, serum concentrations of urea and creatinine do not necessarily accurately reflect renal function'''
** '''Fractional excretion of sodium most accurately measures renal function in a patient with a urinary diversion.'''