Introduction: Use of transverse colon for urinary diversion provides many advantages in the setting of proximal ureteral stricture disease, obesity, inflammatory small bowel disease, extensive pelvic radiation, or when a pyelostomy is indicated. However, its infrequent use often leads urologists to avoid utilization of this bowel segment. Thus, we sought to characterize and demonstrate specific intra-operative considerations pertinent to transverse colon conduit urinary diversion surgery.
Methods: We present a 70-year-old female with an end-stage bladder and bilateral proximal ureteral strictures managed with bilateral nephrostomy tubes. She presented for consideration of urinary reconstruction. After discussion of urinary diversion options, the patient elected for a transverse colon conduit in the setting of her proximal ureteral stricture disease.
Results: A transverse colon conduit urinary diversion was performed in 480 minutes with an estimated blood loss of 500cc. There were no complications. Direct anastomosis of the transverse colon conduit to the renal pelvis was achieved without tunneling the conduit through the colon mesentery. An end to end, hand-sewn, bowel anastomosis was performed with omental flap coverage. We highlight appropriate positioning of the conduit in relation to the bowel anastomosis as well as key decision-making points when performing ureterocolonic and colonic bowel anastomoses given the anatomic differences in the colon mesentery vasculature.
Conclusions: Transverse colon offers many unique benefits when used for conduit urinary diversion. Specific advantages include orthotopic ureterocolonic anastomosis without the need to tunnel the conduit/ureters through the mesentery and the ability to avoid usage of irradiated small bowel. Additional studies assessing short and long-term outcomes are needed to fully characterize perioperative outcomes.