Intestinal Segments and Urinary Diversion - Revision history

Urology4all: /* Complications of urinary intestinal diversion */

2024-03-22T19:43:07Z

Complications of urinary intestinal diversion

Urology4all: /* Colon Conduit */

2024-03-22T19:40:20Z

Colon Conduit

← Older revision		Revision as of 13:40, 22 March 2024
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	=== Colon Conduit ===		=== Colon Conduit ===
	* '''Commonly used colon conduits: transverse, sigmoid, and ileocecal'''		* '''Commonly used colon conduits: transverse, sigmoid, and ileocecal'''
	** '''Transverse colon~~'''~~
	*** '''Used in patients with prior extensive pelvic irradiation or when an intestinal pyelostomy needs to be performed.'''		==== Transverse colon ====
	** '''Sigmoid conduit~~'''~~		* '''Used in patients with prior extensive pelvic irradiation or when an intestinal pyelostomy needs to be performed.'''
	*** '''Good choice in patients undergoing a pelvic exenteration who will have a colostomy since no bowel anastomosis needs to be made.'''
	*** '''Contraindications:'''		==== Sigmoid conduit ====
	**** '''When the internal iliac artery has been ligated and the rectum has been left in situ'''		* '''Good choice in patients undergoing a pelvic exenteration who will have a colostomy since no bowel anastomosis needs to be made.'''
	**** '''Extensive pelvic irradiation'''		* '''Contraindications:'''
	** '''Ileocecal conduit~~'''~~		** '''When the internal iliac artery has been ligated and the rectum has been left in situ'''
	*** '''Advantages:'''		** '''Extensive pelvic irradiation'''
	**** '''Provides a long segment of ileum when long segments of ureter need replacement'''
	**** '''Provides colon for the stoma'''		==== Ileocecal conduit ====
	* '''Contraindications ~~to the use of transverse, sigmoid, and ileocecal conduits~~:~~'''~~		* '''Advantages:'''
	*# '''Presence of inflammatory large bowel disease'''		** '''Provides a long segment of ileum when long segments of ureter need replacement'''
	*# '''Disease of segement being considered'''		** '''Provides colon for the stoma'''
	*# '''Severe chronic diarrhea'''
			==== Contraindications (3): ====
			# '''Presence of inflammatory large bowel disease'''
			# '''Disease of segement being considered'''
			# '''Severe chronic diarrhea'''

	=== Jejunal Conduit ===		=== Jejunal Conduit ===

Urology4all: /* Adverse Events */

2024-03-22T19:39:17Z

Adverse Events

Show changes

Urology4all: /* Mechanical (whole-gut irrigation) */

2024-03-22T19:33:37Z

Mechanical (whole-gut irrigation)

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	*'''Mechanical vs. antibiotic'''		*'''Mechanical vs. antibiotic'''

	==== Mechanical (~~w'''hole~~-gut irrigation)~~'''~~ ====		==== Mechanical (whole-gut irrigation) ====
	* '''<span style="color:#ff0000">Reduces the amount of feces/total number of bacteria but not their concentration'''		* '''<span style="color:#ff0000">Reduces the amount of feces/total number of bacteria but not their concentration'''
	* '''Can be done with polyethylene glycol (PEG)–electrolyte solution'''		* '''Can be done with polyethylene glycol (PEG)–electrolyte solution'''

Urology4all: /* Antibiotic */

2024-03-21T23:21:44Z

Antibiotic

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	==== Antibiotic ====		==== Antibiotic ====
	* '''<span style="color:#ff0000">Reduces the bacterial concentration'''		* '''<span style="color:#ff0000">Reduces the bacterial concentration'''
	* '''PERIoperative IV antibiotics appear to be the most important means of preventing infectious complications of intestinal surgery.'''		* '''<span style="color:#ff0000">PERIoperative IV antibiotics appear to be the most important means of preventing infectious complications of intestinal surgery.'''
	**'''Systemic antibiotics must be given before the operative event if they are to be effective.'''		**'''Systemic antibiotics must be given before the operative event if they are to be effective.'''
	***A randomized trial in elective colorectal surgery found that PREoperative antibiotics did not reduce the risk of clinical infections[https://www.ncbi.nlm.nih.gov/pubmed/17443852 §]		***A randomized trial in elective colorectal surgery found that PREoperative antibiotics did not reduce the risk of clinical infections[https://www.ncbi.nlm.nih.gov/pubmed/17443852 §]

Urology4all: /* Mechanical (whole-gut irrigation) */

2024-03-21T23:21:34Z

Mechanical (whole-gut irrigation)

← Older revision		Revision as of 17:21, 21 March 2024
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	==== Antibiotic ====		==== Antibiotic ====
	* '''<span style="color:#ff0000">Reduces the bacterial concentration'''		* '''<span style="color:#ff0000">Reduces the bacterial concentration'''
	* '''A randomized trial in elective colorectal surgery found that PREoperative antibiotics did not reduce the risk of clinical infections§'''		* '''PERIoperative IV antibiotics appear to be the most important means of preventing infectious complications of intestinal surgery.'''
	* '''PERIoperative IV antibiotics appear to be the most important means of preventing infectious complications of intestinal surgery.'''
	**'''Systemic antibiotics must be given before the operative event if they are to be effective.'''		**'''Systemic antibiotics must be given before the operative event if they are to be effective.'''
	* '''If perioperative antibiotics are given, they should be effective against anaerobes because it is complications from these organisms against which perioperative antibiotics appear to be particularly effective.'''		***A randomized trial in elective colorectal surgery found that PREoperative antibiotics did not reduce the risk of clinical infections[https://www.ncbi.nlm.nih.gov/pubmed/17443852 §]
			** '''If perioperative antibiotics are given, they should be effective against anaerobes because it is complications from these organisms against which perioperative antibiotics appear to be particularly effective.'''

	===== '''Adverse Events''' =====		===== '''Adverse Events''' =====

Urology4all: /* Mechanical (whole-gut irrigation) */

2024-03-21T23:19:38Z

Mechanical (whole-gut irrigation)

← Older revision		Revision as of 17:19, 21 March 2024
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	** '''18 trials with 5,805 participants were analyzed'''		** '''18 trials with 5,805 participants were analyzed'''
	** '''No difference in anastomotic leakage or wound infection rates; important to note that many of these studies involved peri-operative intravenous antibiotics and likely crucial in keeping the complication rate low'''		** '''No difference in anastomotic leakage or wound infection rates; important to note that many of these studies involved peri-operative intravenous antibiotics and likely crucial in keeping the complication rate low'''
	** '''Güenaga, Katia F., Delcio Matos, and Peer Wille‐Jørgensen."Mechanical bowel preparation for elective colorectal surgery." Cochrane Database of Systematic Reviews 9 (2011).'''		** '''[https://pubmed.ncbi.nlm.nih.gov/21901677/ Güenaga, Katia F., Delcio Matos, and Peer Wille‐Jørgensen."Mechanical bowel preparation for elective colorectal surgery." Cochrane Database of Systematic Reviews 9 (2011)]'''
	* '''No studies have adequately assessed the safety of omitting mechanical bowel preparation in urologic reconstructive surgery'''		* '''No studies have adequately assessed the safety of omitting mechanical bowel preparation in urologic reconstructive surgery'''

Urology4all: /* Mechanical (whole-gut irrigation) */

2024-03-21T23:19:11Z

Mechanical (whole-gut irrigation)

← Older revision		Revision as of 17:19, 21 March 2024
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	===== Efficacy =====		===== Efficacy =====

	*'''2011 Cochrane review: Mechanical bowel preparation for elective colorectal surgery'''		*'''<span style="color:#ff00ff">2011 Cochrane review: Mechanical bowel preparation for elective colorectal surgery'''
	** '''18 trials with 5,805 participants were analyzed'''		** '''18 trials with 5,805 participants were analyzed'''
	** '''No difference in ~~anastamotic~~ leakage or wound infection rates; important to note that many of these studies involved peri-operative intravenous antibiotics and likely crucial in keeping the complication rate low'''		** '''No difference in anastomotic leakage or wound infection rates; important to note that many of these studies involved peri-operative intravenous antibiotics and likely crucial in keeping the complication rate low'''
	** '''Güenaga, Katia F., Delcio Matos, and Peer Wille‐Jørgensen."Mechanical bowel preparation for elective colorectal surgery." Cochrane Database of Systematic Reviews 9 (2011).'''		** '''Güenaga, Katia F., Delcio Matos, and Peer Wille‐Jørgensen."Mechanical bowel preparation for elective colorectal surgery." Cochrane Database of Systematic Reviews 9 (2011).'''
	* '''No studies have adequately assessed the safety of omitting mechanical bowel preparation in urologic reconstructive surgery'''		* '''No studies have adequately assessed the safety of omitting mechanical bowel preparation in urologic reconstructive surgery'''

Urology4all: /* Contraindications (5): */

2024-03-21T23:18:33Z

Contraindications (5):

← Older revision		Revision as of 17:18, 21 March 2024
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	=== Rationale for Bowel Preparation ===		=== Rationale for Bowel Preparation ===
	*Solid feces may place strain on the anastomosis in the early phase of healing and result in ischemia with subsequent perforation		*Solid feces may place strain on the anastomosis in the early phase of healing and result in ischemia with subsequent perforation
			*In experimental animals, an anastomosis with vascular compromise at the anastomotic line, which would normally result in perforation, heals if the bowel has been properly prepared with antibiotics
	*Infectious complications after radical cystectomy that are a direct result of fecal contamination include		*Infectious complications after radical cystectomy that are a direct result of fecal contamination include
	**Peritonitis		**Peritonitis
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	# '''Cirrhosis'''		# '''Cirrhosis'''
	# '''Severe CKD'''		# '''Severe CKD'''

			===== Adverse Events =====

			*'''Hypokalemia'''
			**'''Vigorous bowel cleansing, even with Go-Lytely or other electrolyte solutions, will often result in low potassium.'''
			*** '''Characteristic signs include muscular weakness with poor respiratory effort causing decreased ventilation in the presence of a normal chest x-ray.'''
			*'''Diarrhea'''

	==== Antibiotic ====		==== Antibiotic ====
	* '''<span style="color:#ff0000">Reduces the bacterial concentration'''		* '''<span style="color:#ff0000">Reduces the bacterial concentration'''
	* '''In experimental animals, an anastomosis with vascular compromise at the anastomotic line, which would normally result in perforation, heals if the bowel has been properly prepared with antibiotics'''
	* '''A randomized trial in elective colorectal surgery found that PREoperative antibiotics did not reduce the risk of clinical infections§'''		* '''A randomized trial in elective colorectal surgery found that PREoperative antibiotics did not reduce the risk of clinical infections§'''
	* '''PERIoperative IV antibiotics appear to be the most important means of preventing infectious complications of intestinal surgery. Systemic antibiotics must be given before the operative event if they are to be effective.'''		* '''PERIoperative IV antibiotics appear to be the most important means of preventing infectious complications of intestinal surgery.'''
			**'''Systemic antibiotics must be given before the operative event if they are to be effective.'''
	* '''If perioperative antibiotics are given, they should be effective against anaerobes because it is complications from these organisms against which perioperative antibiotics appear to be particularly effective.'''		* '''If perioperative antibiotics are given, they should be effective against anaerobes because it is complications from these organisms against which perioperative antibiotics appear to be particularly effective.'''
	'''Adverse Events'''
	*'''~~Vigorous bowel cleansing, even with Go-Lytely or other electrolyte solutions, will often result in low potassium.~~'''		===== '''Adverse Events''' =====
	** '''~~Characteristic signs include muscular weakness with poor respiratory effort causing decreased ventilation in the presence of a normal chest x-ray.~~'''		*'''Diarrhea'''
	*'''Bowel preparations may result in diarrhea and pseudomembranous enterocolitis.'''		*'''Pseudomembranous enterocolitis'''
	** '''Treatment involves the administration of vancomycin or metronidazole and discontinuance of other antibiotics that the patient is receiving.'''		** '''Treatment involves the administration of vancomycin or metronidazole and discontinuance of other antibiotics that the patient is receiving'''

	== Selecting the segment of intestine ==		== Selecting the segment of intestine ==

Urology4all: /* Contraindications (5): */

2024-03-21T23:15:51Z

Contraindications (5):

← Older revision		Revision as of 17:15, 21 March 2024
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	# '''Obstructed bowel'''		# '''Obstructed bowel'''
	# '''Unstable cardiovascular system'''		# '''Unstable cardiovascular system'''
	# '''~~CHF~~'''		# '''Congestive heart failure'''
	# '''Cirrhosis'''		# '''Cirrhosis'''
	# '''Severe CKD'''		# '''Severe CKD'''