UNIT NINE
704
Understanding the Urinary System
and used as a conduit for urine. The remaining portions of the bowel are sutured back together. The surgeon is careful to keep the blood and neurologic supply intact to the sec- tion of bowel that has been removed. The isolated section of bowel is closed off on one end, the ureters are stitched into it, and the other end is brought out as a stoma on the abdomen (urostomy) that then continuously drains urine (Fig. 37.5). The urine from an ileal conduit contains mucus because it travels through the ileum, which normally secretes mucus.
Stent in place
Stent being inserted
Isolated segment of ileum with ureters implanted in posterior portion
A
Stoma on abdomen
Peristalsis
Catheter
Entry through skin
A
Tape
Drainage tubing
Ureters implanted into pouch
Indiana pouch formed from cecum
Portion of terminal ileum exits abdominal wall
Posterior view B FIGURE 37.4 (A) Ureteral stents. (B) Nephrostomy tube inserted into renal pelvis; catheter exits through an incision on flank.
B
resectoscope with fulguration (destruction of tissue with electrical current) may be done to burn off cancerous tis- sue that has not invaded the muscle of the bladder wall. Alternately, a laser can be used with the resectoscope to destroy the tumor tissue. Robotic and laparoscopic surgical techniques may be used. Partial cystectomy can be done if cancer is limited to one area. If it is not, then radical cystec- tomy to remove the entire bladder and surrounding lymph nodes and other structures is needed. Reconstructive surgery is done after a radical cystectomy to create one of the types of urinary diversion (urine is stored and leaves the body in a different way). INCONTINENT URINARY DIVERSION. An ileal conduit is used mainly for patients who have other health issues, the inability to care for a continent diversion, or a limited life span. A 6- to 8-inch section of the ileum or colon is removed
Ureters implanted into neobladder
Neobladder
Uretha
C
FIGURE 37.5 Urinary diversion surgery. (A) Ileal conduit. (B) Indiana pouch. (C) Orthotopic neobladder.
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