50820 Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation)

Name of the Procedure:

Ureteroileal Conduit (Ileal Bladder), Bricker Operation

Summary

A ureteroileal conduit (also known as the Bricker operation or ileal bladder) is a surgical procedure that creates a new way for urine to leave the body after the bladder is removed. A segment of the intestine is used to form a conduit that connects the ureters (tubes carrying urine from the kidneys) to a stoma (an opening on the abdomen).

Purpose

The procedure addresses the need to reroute urine flow due to bladder removal, typically because of cancer, severe bladder disease, or congenital anomalies. The goal is to provide a functional urinary diversion that allows normal kidney function and urine excretion.

Indications

• Bladder cancer requiring cystectomy (bladder removal)
• Severe bladder dysfunction or damage from conditions like interstitial cystitis or spinal cord injury
• Congenital defects leading to non-functional or absent bladder

Preparation

• Pre-procedure fasting usually required (NPO after midnight)
• Adjustments in medication (e.g., blood thinners) as instructed by the physician
• Diagnostic tests including blood work, imaging studies (e.g., CT scan, MRI), urine tests, and urodynamic studies
• Bowel preparation may be required

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Abdominal Incision: An incision is made in the lower abdomen.
3. Bladder Removal: The bladder is surgically removed.
4. Intestine Section: A segment of the ileum (part of the small intestine) is isolated.
5. Conduit Creation: The isolated ileal segment is fashioned into a conduit.
6. Ureteral Anastomosis: The ureters are detached from the bladder and connected to the ileal conduit.
7. Stoma Formation: One end of the conduit is brought out through an incision in the abdomen to form a stoma.
8. Closure: The abdominal incision is closed.

Tools: Scalpels, sutures, staplers, retractors, surgical clips, electrocautery devices.

Duration

The procedure typically takes between 4 to 6 hours.

Setting

Performed in a hospital operating room.

Personnel

• Urologist or Surgical Oncologist (Surgeon)
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses

Risks and Complications

• Infection
• Blood clots
• Intestinal obstruction
• Urine leakage from the anastomosis
• Electrolyte imbalances
• Stoma complications (e.g., retraction, infection)

Benefits

• Removes the diseased or cancerous bladder
• Provides a functional urinary diversion
• Improves quality of life without a urinary bladder

Recovery

• Hospital stay of about 7-10 days
• Pain management with medications
• Stoma care education
• Gradual return to normal activities over 6 weeks
• Regular follow-up appointments to monitor function and detect complications

Alternatives

• Continent urinary diversion (e.g., Indiana pouch)
• Orthotopic neobladder (internal pouch created from intestine)
• Pros: Continent options avoid an external stoma.
• Cons: More complex surgeries with potentially higher complication rates.

Patient Experience

Patients will be under general anesthesia during the procedure and will not feel pain. Post-operative pain can be managed with medications. Patients will need to adapt to living with a stoma, which includes learning stoma care and management. Symptoms such as soreness and fatigue are normal and improve over several weeks.