Editing Intestinal Segments and Urinary Diversion (section)

==== <span style="color:#0000ff">I</span><span style="color:#ff0000">nfections ====
* An increased incidence of bacteriuria, bacteremia, and septic episodes occurs in patients with bowel interposition.
* '''≈75% of ileal conduit urine specimens are infected.''' Many of these patients, however, show no untoward effects and seem to do well with chronic bacteriuria.
** Deterioration of the upper tracts is more likely when the culture becomes dominant for Proteus or Pseudomonas. '''Thus patients with relatively pure cultures of Proteus or Pseudomonas should be treated, whereas those with mixed cultures may, in general, be observed, provided they are not symptomatic.'''
* '''Pouchitis'''
** '''Not uncommon, especially in the early postoperative period when mucous accumulation can be high.'''
** '''A simple program of mechanical irrigation can decrease the incidence of infections, though asymptomatic colonization may not decrease'''
* '''Pyocystis'''
** '''Ooccurs in ≈20% of patients who undergo supravesical diversion.'''
** '''Patients typically have a malodorous discharge and may develop sepsis.'''
** '''If conservative measures, such as routine bladder irrigations fail, vaginal vesicostomy (creation of a large vesico-vaginal fistula), is an effective method of preventing pyocystis in women. This is an especially good alternative for an elderly or high risk patient. Cystectomy is an effective treatment for pyocystis and would likely be required if the patient was a male'''