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Colon Conduit: Surgical Technique (Step-by-Step) and Complications

Definition and Indications for Colon Conduit

The colon conduit is an incontinent heterotopic urinary diversion after cystectomy. The ureters are anastomosed with a short colonic segment, which is passed through the abdominal wall as a stoma. A colonic conduit should be preferred over an ileal conduit in the following situations: Pelvic irradiation, absence of distal and mid ureter, short bowel syndrome, and Crohn disease of the ileum.

Contraindications for Colon Conduit

Colon diseases, e.g., cancer, ulcerative colitis, or sigmoid diverticulitis. Ureterocutaneostomy should be considered as an alternative in patients with a short life expectancy.

Step-by-Step Surgical Technique of Ileal Conduit

Preoperative patient preparation:

Please see the section on radical cystectomy.

Colon dissection:

The transverse colon is used if a stomal localization in the upper abdomen is desired, after pelvic irradiation, or if the ureters are very short. Alternatively, the sigmoid colon can be used. A colon segment of 20 cm in length is sufficient for a conduit. The middle colic artery is the vascular supply for a segment of the transverse colon, or the inferior mesenteric artery for a segment of the sigmoid colon. Close the oral end of the colon segment with a running suture. Implant the ureters at the taenia libera with an antirefluxive or refluxive technique, see the following paragraphs.

Dissection of the ureters:

The ureters are splinted with MJ ureteral stents (secured with 4-0 fast absorbing sutures), which allows for the atraumatic management of the ureters during the next steps. Dissect the ureters as little as possible to maintain their blood supply (caution: ureteral stricture).

Refluxing ureterocolonic anastomosis:

Ureterocolonic anastomosis is possible using a technique analogous to Bricker or Wallace; see the previous section ileal conduit.

Nonrefluxing ureterocolonic anastomosis:

Inject saline into the taenia libera to ease further dissection. Perform a longitudinal incision (2--3 cm) of the tania without opening the mucosa. Dissect the mucosa of the muscularis to create a space for the ureter. Anastomose the ureter with the mucosa with interrupted sutures (PDS 5-0). The nonrefluxing mechanism is created by closing the seromuscular layer over the ureter with loose interrupted sutures.

A transcolonic antirefluxive ureteral implantation is also possible (analogous to ureterocystoneostomy): partial opening of the colonic conduit, submucosal tunneling with overholt clamp, implantation of the ureter as in UCN. Closure of the colonic conduit.

Stoma:

Please see the section ileal conduit.

Postoperative Care After Ileal Conduit

Please see the section urinary diversion for postoperative care.

Complications of Ileal Conduit

Please see the section ileal conduit for complications.

References

Hautmann 2003 HAUTMANN, R. E.: Urinary diversion: ileal conduit to neobladder.
In: J Urol
169 (2003), Nr. 3, S. 834–42

Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I. Long-term complications of conduit urinary diversion. J Urol. 2011 Feb;185(2):562-7. doi: 10.1016/j.juro.2010.09.096.

  Deutsche Version: Technik und Komplikationen des Kolonkonduits