Urinary Diversions

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Urinary Diversions

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• 6.3.06

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• 1851 Ureteroproctostomy (Simon)
• 1878 Ureterosigmoidostomy (Smith)
• 1898 Rectal bladder (Gersuny)
• 1950s Ileal conduit (Bricker)
• 1959 Ileal neobladder (Camey)
• 1970s Kock pouch
• Early 1980s Indiana pouch
• Late 1980s Orthotopic diversion

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• Bladder cancer
• Neurogenic bladder
• Detrusor over-activity
• Chronic inflammatory conditions (interstitial
  cystitis, TB, schistosomiasis, post-radiation
  bladder contraction)

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• pH ??????????? ????

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• ?????? H/K
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• Hypochloremic hypokalemic metabolic alkalosis

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• Hematuria-dysuria
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• Hypochloremic, hyponatremic, hyperkalemic,
  metabolic acidosis

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Jejunal conduit syndrome

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• Hyperchloremic hypokalemic () metabolic acidosis
  

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• Urea splitting bacteria
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• Phenytoin
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• Methotrexate
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• Bladder exstrophy
• Neurogenic bladder
• Valve bladder
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  Pseudomonas)
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• ????? ?? ??????? ?????? (urea splitting)
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Malabsorption
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  ?? ????? (Ureterosigmoidostomy)