PALLIATIVE INTERNAL URINARY-DIVERSION WITH A PROXIMAL SMALL-BOWEL SEGMENT

Conventional strategies of urinary diversion do not appreciate the sur gical patient who already has an ileostomy or colostomy. To increase t he quality of life, we have looked for a different type of urinary div ersion for those patients. The superior results of the Roux-en-Y recon struction in small bowel disease have stimulated us to use this type o f procedure for unilateral urinary diversion. Because of the special a bsorption conditions we used a proximal small bowel segment for the an astomosis of the ureters. By doing this the bowel contents are not sig nificantly diluted. We did not find any metabolic changes or electroly te disturbances, especially no potassium loss and no alteration of the calcium metabolism. However, this might be explained by compensation of the contralateral kidney. An ascending infection is unlikely, as ha s been shown with the biliodigestive anastomosis, especially since the flow is higher than in a biliodigestive anastomosis. Our results with the unilateral internal urinary diversion let us recommend this proce dure for patients with a limited life-span. Recurrent obstruction as s een in cases with a reimplantation of the ureter into the urinary blad der is unlikely, the operative risk is relatively low.