Name of the Procedure:

Revision of Urinary-Cutaneous Anastomosis
Common name(s): Urostomy Revision, Ileal Conduit Revision

Summary

A revision of urinary-cutaneous anastomosis is a surgical procedure performed to correct or improve a previously created urostomy. A urostomy is an opening in the abdomen that allows urine to be diverted out of the body.

Purpose

This procedure addresses complications or functional issues with an existing urostomy, such as stenosis (narrowing), leakage, or infection. The goal is to restore proper urine flow, reduce complications, and improve the patient's quality of life.

Indications

• Stenosis or blockage of the stoma
• Persistent leakage around the stoma
• Stoma infection or severe skin irritation
• Prolapse or retraction of the stoma
• Poorly functioning urostomy leading to recurrent urinary tract infections

Preparation

• Fasting typically required from the night before the procedure
• Adjustment of medications as instructed by healthcare provider
• Blood tests, imaging studies, or urodynamic tests to assess the current urostomy function and anatomy

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free.
2. Initial Incision: An incision is made around the existing stoma and into the abdominal wall.
3. Revision: The surgeon will assess and correct any narrowing, leakage, or malposition of the stoma. This may involve cutting away scar tissue, reshaping the stoma, or rerouting the urinary diversion.
4. Stoma Closure and Redraping: The new stoma is carefully sutured in place and the abdominal wall is closed.

Tools: Scalpels, scissors, sutures, urinary catheters, specialized surgical instruments
Anesthesia: General anesthesia

Duration

The procedure typically takes about 2 to 4 hours, depending on the complexity of the revision.

Setting

Performed in a hospital operating room.

Personnel

• Surgeon (usually a urologist or specialized surgeon)
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Stoma retraction or prolapse post-surgery
• Persistent leakage or stenosis
• Damage to surrounding organs or tissues

Benefits

• Improved urine flow and reduced risk of infection
• Better stoma function and reduced complications
• Enhanced quality of life and comfort for the patient

Recovery

• Pain management with prescribed medications
• Monitoring in the hospital for 1-2 days post-surgery
• Instructions on stoma care, hygiene, and potential signs of complications
• Follow-up appointments for stoma assessment and healing

Alternatives

• Conservative management: modifications in stoma care and use of stoma appliances
• Ureteral stents or balloon dilatation for minor stenosis
• Catheterization methods for short-term relief

Pros and Cons: Alternatives may offer temporary relief or be less invasive but might not solve underlying issues like surgical revision can.

Patient Experience

• Likely pain and discomfort managed with medication
• Initial swelling and tenderness around the stoma site
• Gradual improvement in symptoms over weeks to months
• Wound care and stoma oversight during healing phase