Ureterocolon conduit, including intestine anastomosis
CPT4 code
Name of the Procedure:
Ureterocolon Conduit (also known as Ureterocolonic Anastomosis)
Summary
In layman's terms, a ureterocolon conduit is a surgical procedure where the surgeon reroutes the ureters to a section of the colon to allow urine to pass from the kidneys to be expelled through the large intestine. This involves connecting the ureters to an isolated segment of the colon.
Purpose
The procedure is commonly performed to address conditions where the bladder is non-functional or has been removed due to diseases such as cancer, congenital abnormalities, or severe bladder dysfunction. The primary goal is to allow urine to be excreted from the body when normal urinary pathways are not viable.
Indications
- Bladder cancer requiring bladder removal
- Severe bladder dysfunction
- Congenital abnormalities of the bladder or ureters
- Traumatic injury to the bladder rendering it non-functional
- Chronic urinary tract infections caused by dysfunctional bladder
Preparation
- Fasting from midnight before the surgery
- Adjusting or stopping certain medications as advised by the physician
- Undergoing preoperative imaging studies such as CT scans or ultrasounds
- Blood tests to assess kidney function and overall health
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the abdomen to access the urinary and gastrointestinal tracts.
- A segment of the colon is isolated and detached from the rest, with care taken to maintain blood supply.
- The ureters are attached (anastomosed) to this isolated segment of the colon.
- The remaining part of the colon is reconnected to ensure normal bowel function.
- The incision is closed, and the patient is monitored as anesthesia wears off.
Tools, equipment, or technology used include surgical instruments for cutting and stitching, possibly laparoscopic tools, and anesthesia equipment for sedation.
Duration
The procedure typically takes 4-6 hours, depending on the complexity and patient's condition.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Lead surgeon (urologist or general surgeon with specialized training)
- Surgical assistants
- Anesthesiologist
- Scrub nurses and circulating nurses
Risks and Complications
- Infection at the surgical site
- Leakage at the site of anastomosis
- Bowel obstruction
- Blood clots
- Kidney infections
- Electrolyte imbalances
- Risk associated with general anesthesia
Benefits
- Restoration of urinary excretion function when the bladder is non-functional
- Improvement in the quality of life by reducing the risk of kidney damage and recurrent infections
- Potential long-term relief from the symptoms of a non-functional or diseased bladder
Recovery
- Hospital stay for 1-2 weeks post-surgery for monitoring
- Gradual reintroduction to normal diet
- Instructions on wound care and signs of infection to watch for
- Follow-up appointments for imaging and blood tests to monitor kidney function
- Restrictions on heavy lifting and strenuous activities for several weeks
Alternatives
- Ileal conduit urinary diversion
- Neobladder reconstruction
- Use of external urinary management devices
- Each alternative has its own set of risks and benefits which should be discussed with a healthcare provider.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Post-procedure, the patient may experience discomfort or pain at the incision site, which can be managed with pain medications. Adjustments to diet and activities are necessary during the recovery period, and close follow-up with healthcare professionals will ensure proper healing and functionality.