Utility of intestinal segments in Reconstructive Urology - Experience at a tertiary level government setup

B. Prakasa Rao; Aditya Sharma

Volume : IX, Issue : II, February - 2020

Utility of intestinal segments in Reconstructive Urology - Experience at a tertiary level government setup

B. Prakasa Rao, Aditya Sharma

Abstract :

Introduction: - in fairly recent years bowel has been used frequently in reconstructive Urology, and has become a very important weapon for a reconstructive urologist for dealing with various reconstructive problems in both pediatrics and adult patients. Due to these weapons there has been a revolution in what a urologist can do whenever he faces a severe anomaly in a child, such as cloacal exstrophy, or reconstruction in an adult patient of bladder cancer. Materials and Methods: - Here we present a series of 19 cases that were operated at Department of Urology, Government General Hospital Guntur from Feb 2017 to Dec 2019. With the aim to analyse various procedures done using intestines, to analyse the complications, to compare the various types of intestinal complications and to compare the results with various studies published. Results: - Out of 19 cases done at Government General Hospital, Guntur in the past 23 months, we had long term successful outcomes in 18 cases, with 1 case of Mitrofanoff procedure done for recurrent uretheral stricture requiring life-long suprapubic cystostomy. In the immediate post-operative period 2 case of Radical Cysto-prostatectomy with ileal conduit, 1 case of augmented cystoplasty using ileum developed surgical site infection. Most common complications in the immediate post-operative period were pain, ileus and electrolyte imbalance namely hypokalemia. In patient where sigmoid was used as the intestinal substitute, the patient had to be kept on irrigation,N-acetyl Cysteine and soda bicarbonate were used as mucolytics. Average post-operative hospital stay for the patients was 18 days. All the patients are still on follow-up and are doing well with no complications. Conclusion: -Intestines are used in many forms as conduits, pouches, augmentation and orthotopic diversion. Various techniques have been described in literature including continent diversion and incontinent diversions. Meticulous care in anastomosis is must in uretero-enteric, intestine to intestine and intestine to thimble bladder.