50830 Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)

Name of the Procedure:

Urinary Undiversion (e.g., Taking Down of Ureteroileal Conduit, Ureterosigmoidostomy, or Ureteroenterostomy with Ureteroureterostomy or Ureteroneocystostomy)

Summary

Urinary undiversion is a surgical procedure to restore the natural flow of urine by reversing urinary diversions such as ureteroileal conduits, ureterosigmoidostomies, or ureteroenterostomies. This means reconnecting the ureters to the bladder or another part of the urinary tract.

Purpose

Urinary undiversion addresses complications of previous urinary diversion surgeries, such as urinary infections, stone formation, and impaired quality of life. The goal is to restore normal urination, improve kidney function, and enhance the patient's overall well-being.

Indications

• Recurrent urinary tract infections
• Kidney stones
• Deterioration of kidney function
• Problems with the stoma or urinary diversion site
• Patient preference for fewer lifestyle restrictions related to urinary diversions

Preparation

• Fasting for at least 8 hours prior to surgery
• Stopping certain medications as instructed by the healthcare provider
• Preoperative imaging tests (e.g., CT scan, ultrasound)
• Blood tests to assess kidney function and overall health

Procedure Description

1. Anesthesia is administered to ensure the patient is pain-free and comfortable.
2. The surgeon makes an incision to access the existing urinary diversion.
3. The ureters are carefully disconnected from the diversion site.
4. The ureters are re-routed and connected to the bladder, another part of the urinary tract, or reconstructed as necessary.
5. Any additional procedures, such as removing kidney stones, may be performed.
6. The incision is closed, and a catheter may be placed to ensure proper urinary drainage during the initial healing period.

Duration

The procedure typically takes 4-6 hours, depending on the complexity and any additional procedures required.

Setting

The procedure is performed in a hospital in a specialized operating room.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Injury to nearby organs or blood vessels
• Urinary leakage or blockage
• Recurrent urinary tract infections
• Need for additional surgeries
• Anesthesia-related complications

Benefits

• Restoration of normal urinary function
• Improved kidney function
• Reduced risk of infections and stone formation
• Enhanced quality of life with fewer lifestyle restrictions

Recovery

• Hospital stay of around 5-7 days for monitoring and initial recovery
• Pain management with medications as needed
• Instructions to maintain hydration and avoid strenuous activities for several weeks
• Follow-up appointments for imaging and function tests
• Gradual return to normal activities typically within 6-8 weeks

Alternatives

• Continued management of existing urinary diversion with medical therapy
• Minimally invasive procedures to address specific complications without complete undiversion
• Pros of alternatives include potentially lower risk and shorter recovery times. Cons include continued inconvenience and potential future complications related to the diversion.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-operatively, there may be discomfort at the incision site and some pain managed with medications. The patient may have a catheter for a few days or weeks and will need to follow specific care instructions to ensure proper healing and prevent infections. Pain and discomfort typically reduce significantly within the first week, and full recovery is expected within 6-8 weeks.