Urinary diversion surgery is a surgical procedure used to reconstruct the urinary tract, primarily for patients who have lost bladder function due to disease or trauma. This treatment involves creating an alternative urinary pathway using artificial or autologous tissue, allowing patients to effectively excrete urine and prevent renal impairment or urinary retention. The surgery is suitable for conditions such as end-stage bladder disease, severe urethral obstruction, or post-cystectomy for bladder cancer, aiming to restore basic physiological functions and improve quality of life.
Depending on patient needs and the severity of the condition, urinary diversion surgery can be divided into three main types:
1. Ileal Conduit: A segment of the small intestine is fashioned into a urine collection conduit, with the end connected to the abdominal wall to drain urine into an external collection bag.
2. Continent Diversion: An internal reservoir is constructed using intestinal segments, allowing patients to drain urine via percutaneous puncture, avoiding reliance on external urinary bags.
3. Neobladder Reconstruction: Using intestinal tissue to reconstruct a new bladder connected to the urethra, mimicking normal urination, but requiring training for voiding.
This surgery is mainly indicated for the following conditions:
The procedure is performed under general anesthesia, with operative time depending on the type of diversion, typically lasting 4-8 hours. Postoperative hospitalization usually lasts 7-14 days for wound care and functional training. Postoperative care includes:
The main advantages of this treatment include:
Potential complications include:
Preoperative assessment includes renal function and cardiopulmonary status. Contraindications include:
This surgery is often combined with the following treatments:
According to the 2019 Urology Medical Yearbook, the 5-year survival rate and renal function preservation rate for neobladder patients reached 83%, while continent diversion reduced skin irritation risks by 30%. Long-term follow-up shows that 70% of patients can adapt to external urinary collection, but ongoing monitoring of intestinal and renal function is necessary.
If patients cannot undergo surgery, alternatives include:
Preoperative assessments typically include detailed urological examinations and adjustments to chronic disease medications based on health status. A low-residue diet for three days prior to surgery may be recommended to reduce bowel contents, and anticoagulant medications should be temporarily discontinued to lower bleeding risk. The nursing team will provide instructions on personal hygiene preparations, such as cleaning the surgical site.
How long does it take to recover urination function in the early postoperative period? What activities should be avoided in daily life?Initially, due to stoma or artificial bladder adaptation, patients may need to use collection devices or perform regular irrigations. Recovery of urination function typically takes several weeks to months, with pelvic floor muscle training guided by physical therapists. During the first three months post-surgery, patients should avoid heavy lifting, vigorous bending, and prolonged standing to prevent stress on sutures.
Which long-term complications require immediate medical attention? How can infection risks be prevented?If symptoms such as high fever, redness, swelling, warmth, pain at the drainage site, abnormal bleeding, or urine leakage occur, seek medical attention within 24 hours. Daily cleaning of the skin around the stoma, using medical leak-proof ointments, and periodic rinsing of the collection system with antibiotic solutions are recommended. Patients with immunosuppression should have increased follow-up frequency.
What dietary adjustments are needed post-surgery? Which foods may increase the risk of complications?Increasing high-fiber vegetables and whole grains is advised to prevent constipation and excessive abdominal pressure. Spicy, high-sugar, and processed foods should be minimized to avoid irritating the urinary tract or promoting infection. For ileal neobladder, a low-protein diet may be recommended initially to reduce ammonia production, gradually transitioning to a normal diet later.
What is the approximate improvement rate in quality of life after surgery? What factors influence long-term outcomes?Studies indicate that about 70-80% of patients can resume basic daily activities within one year post-surgery, but precise control of urination may require a longer adaptation period. The success rate is influenced by the severity of the primary disease, choice of surgical method, and patient adherence to postoperative care. Regular monitoring of renal function and urinary imaging can detect complications early and improve long-term results.
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