Ureterosigmoidostomy

Ureterosigmoidostomy is a surgical I method of urinary drainage through which the ureters are implanted into the sigmoid colon, through which urine is passed into the large bowel and is excreted with feces. It is most often done after bladder removal (cystectomy) or for certain congenital or neurogenic bladder disorders.

This procedure omits an ostomy, but demands vigilant life-long surveillance.

When Should Ureterosigmoidostomy Be Considered?

• Bladder cancer needing cystectomy (select cases)
• Congenital bladdermalformations (e g bladder exstrophy)
• Neurogenic bladder with profound dysfunction
• Failed previous urinary diversion
• Patients who are strongly interested in not having an external urostomy bag

Ureterosigmoidostomy: Pros 

• There is no external stoma or urine bag
• For some patients a better body image
• Anal sphincter allows continence via the
• No need for intermittent catheterization

Ureterosigmoidostomy procedure

Ureterosigmoidostomy is utrinary diversion technique in where two ureters are anastomosed into the sigmoid colon and urine is then excreted into the stool through the large bowel. It is generally done following cystectomy or in certain congenital and neurogenic bladder cases. 

Preoperative Preparation

• Renal function tests and serum electrolytes should be completed
• Imaging (CT urogram / ultrasound kidneys)
• Colon evaluation (usually colonoscopy)
• Bowel prep
• Broad spectrum antibiotics
• Counselling about long term risk and follow-up

Procedure:

Anaesthesia and Positioning

• General anaesthesia
• Supine position
• Abdominal approach (open / laparoscopic / robotic)

Mobilization of Ureters

• Both ureters are identified
• Carefully mobilized, preserving the blood supply.
• Distal ends are spatulated to avoid stricture

Preparation of Sigmoid Colon

• The sigmoid colon is mobilized
• Two implantation sites are chosen (usually 3–5 cm apart)
• Seromuscular incisions are made

Anti-Reflux Implantation

• A submucosal tunnel is formed in the colon wall

Ureters are tunneled

• Ureteric ends are anastomosed to colonic mucosa
• (This minimizes reflux of fecal matter into the ureters)

Ureteric Stenting

• Temporary ureteric stents may be placed
• Promotes healing and prevents obstruction

Closure

• Check for leak anastomoses
• Abdomen closed in layers
• Drains placed if needed

Duration of Surgery

• 3 to 5 hours, depending on the approach and complexity

Postoperative Care

• Nil per oral initially, gradual diet advancement
• IV fluids and electrolytes monitoring
• Monitor acid-base status
• Antibiotics
• Early ambulation
• Removal of ureteric stents after 10–14 days (if placed)

Ureterosigmoidostomy complications

Ureterosigmoidostomy is a continent urinary diversion, but it carries substantial short- and long-term morbidity and is therefore currently reserved for highly selected patients with the need for lifelong surveillance.

Early (Immediate) Complications

• Anastomotic Leak
• Ileus
• Infection
• Bleeding
• Ureteric Obstruction

Late Complications

• Metabolic Complications
• Recurrent UTIs
• Renal Deterioration
• Fecal Incontinence & Bowel Dysfunction
• Electrolyte Imbalance

Long-Term Complications

• Colorectal Malignancy
• Ureteric Stricture
• Chronic Diarrhea

Ureterosigmoidostomy recovery

Recovery following ureterosigmoidostomy requires short-term postoperative healing and long-term physiological adaptation, since urine is drained into the sigmoid colon. Renal function must be carefully monitored to minimize metabolic consequences.

Immediate Postoperative Recovery (First 1-7 days)

In the Hospital

• ICU/High dependence care for the first 24–48 hours (if necessary)
• Nil by mouth initially → gradual liquids → soft diet
• IV fluids with frequent monitoring of electrolytes and acid-base status
• Pain control (epidural or IV analgesia)
• Broad-spectrum antimicrobials
• Early ambulation to prevent clots and ileus
• Abdominal drains monitored and removed as appropriate

What the Patient Experiences

• Frequent loose stools mixed with urine
• Abdominal distention or bloating
• Fatigue and fatigue

Early Recovery Phase (1-4 Weeks)

At Home

• Gradual increase in the level of activity
• Do not lift anything heavy for 4‐6 weeks.
• Maintain high fluid intake
• Follow prescribed alkali therapy (e.g. and sodium bicarbonate) if directed.
• Take antibiotics if prescribed.

Adaptation of the Bowel

• The number of stools drops off slowly.
• They develop better control over their bowel movements.
• Frequency of bowel movements at night may also persist at first.

Ureteric Stents & Follow-up

• If ureteric stents were inserted, they are usually taken out after 10–14 days.

First follow-up visit is including:

• Blood work (kidney function, electrolytes)
• Ultrasound of kidneys.
• Assessment of bowel and continence status.

Recovery Long Term (Months to Years) 

Physiological Adjustment

• Colon adjusts to urine contact with time.
• Most patients’ bowel habits normalize.
• Some patients always need alkalai supplementation.

Lifestyle

• Regular hydration
• Treatment of diarrhea promptly
• Prevent dehydration and constipation.
• Dietary changes to reduce the risk of acidosis.

Recovery diet

Advice

• Adequate fluids (unless restricted)
• Balanced diet with a good supply of fruit and vegetables
• Potassium containing foods (unless contraindicated)
• Small, frequent meals initially

Avoid / limit

• Too much salt
• Caffeine and alcohol
• Foods that cause diarrhea

Best hospital ureterosigmoidostomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Ureterosigmoidostomy is a continent urinary diversion in which urine is eliminated via the bowel, obviating the need for an external stoma. Though it has potential benefits for body image and continence, it incurs significant short- and long-term metabolic, infectious, renal, and oncologic risks. Good results require appropriate patient selection, careful surgical technique, and a rigorous life-long follow-up commitment. Frequent surveillance of kidney function, electrolytes, bowel health, and colonoscopic surveillance are necessary in order to prevent life-threatening complications.

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FAQ

1. Is total Urine & stool mix up after surgery?

• Yes. After ureterosigmoidostomy, the urine mixes with stool and is discharged from the anus.

2. Is continence expected after this surgery?

• Yes, good anal and sphincters functioning is a must for continence. Most patients can keep their bowels, albeit with more frequent stooling.

3. Is ureterosigmoidostomy applicable for paediatric population?

• It can be done in selected cases in children but they are at higher long-term risk and other, more modern, options are generally preferred.

4. Can the process be reversed?

• If there are complications, a ureterosigmoidostomy may be converted into another urinary diversion, such as an ileal conduit.