Ileal conduit for bladder cancer

[Kristian Cauchi Inglott]

Hi everyone,

First of all please let me know if I am posting this in the wrong sub-forum etc... Not really sure where to post at the moment, its my first time.

I'm studying urology at the moment, and I'm reading that in the case of a cystectomy, with the formation of an ileal conduit to void urine, you must measure B12 and folate levels, as a section of ileum is removed.

Simple question, why then isn't a segment of jejunum used for the conduit rather than ileum?

Thanks

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[Domepiece]

That's an excellent question that I wish I had a well thought out answer to! Probably better asked in the Urology surgical subspecialty forum.

I would presume that besides the duodenum, any segment of intestinal tissue could theoretically be used, but the terminal ileum is probably the easiest to locate and likely has a great location given the short distance to move for creation of a conduit, allowing minimization of potential blood flow issues and preservation of normal kidney drainage with the ureters being nearby.

Maybe @cpants or @DoctwoB can weigh in?

 

[DoctwoB]

That's an excellent question that I wish I had a well thought out answer to! Probably better asked in the Urology surgical subspecialty forum.

I would presume that besides the duodenum, any segment of intestinal tissue could theoretically be used, but the terminal ileum is probably the easiest to locate and likely has a great location given the short distance to move for creation of a conduit, allowing minimization of potential blood flow issues and preservation of normal kidney drainage with the ureters being nearby.

Maybe @cpants or @DoctwoB can weigh in?

The problem with jejunum is absorption. For a urinary conduit or neobladder you want the surface to absorb as little as possible of the junk that your kidneys found it necessary to excrete. The jejunum is the most absorptive part of the small intestine (increased villous architecture) and is also smaller in capacity which is not ideal. While ileum and colon conduits can give you a hyperchloremic acidosis, Jejunum can also throw in hyponatremia and hyperkalemia into the mix.

Colon also works well and is a usual backup if ileum isn't available or is radiated, but requires a larger ostomy/fascial opening and likely have a higher hernia rate. Gastric conduits give problems because you're constantly losing acid to you get alkalotic.

 

[Kristian Cauchi Inglott]

Thank you !