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Urinary Intestinal Diversion (von Französisch in Englisch)

Urinary Intestinal Diversion

(Urology Dept. - Hôpital Tenon - 4, rue de la Chine - 75020 Paris - France)

The use of urinary intestinal diversion was first described by Simon in 1852. This was a uretero-rectal implant for exstrophy of the bladder. In 1931, Boyd reported a case of chronic metabolic acidosis after ureterosigmoidostomy.

The ever-frequent use of continent urinary diversion after total cystectomy has raised once again the subject of the metabolic and clinical consequences of prolonged contact between urine and the intestinal mucosa.

Prolonged contact between urine and the intestinal mucosa is of course not physiological. It results in the reabsorption of electrolytes from the urine by the intestinal mucosa and can lead to serious metabolic consequences for the organism. Indeed, there can be metabolic consequences in distant organs.

I. The Normal Mechanisms of Water and Electrolyte Transport in the Intestine:

Each part of the intestine has its own physiological characteristics:

• The jejunum, which is seldom used for urinary diversion, has numerous villi and micro-villi to increase the surface area of absorption for fluids and electrolytes. Furthermore, its mucosa has large pores which increase its capacity for absorption as compared to the ileum.

The main mechanism of water and electrolyte absorption is passive and depends on the electrical, chemical and osmotic gradients present. In addition, there exists a mechanism for the active reabsorption of sodium. Urea is reabsorbed in the jejunum in line with the osmotic gradient.