Jejunal conduits: technique and complications

Thirty patients underwent jejunal urinary diversion: 27 bilateral cutaneous ureterojejunostomies, 2 cutaneous pyeloureterojejunostomies and 1 bilateral pyelocutaneous jejunostomy. In the majority of the cases this high diversion was indicated for malignant disease with preoperative and postoperative irradiation of the pelvis. Postoperative morbidity in these cases is not different from thatin cases of ileal conduit operation, except for a high incidence of reversible hypochloremic acidosis with hyponatremia, hyperkalemia and uremia. This electrolytic syndrome is the consequence of a continuous exchange of ions between the jejunal content and the extracellular fluid with resultant loss of sodium chloride and absorption of potassium and urea. An important link in the pathophysiology of the jejunal syndrome is the hypersecretion of renin-aldosterone, which aggravates the disturbance. Limited renal function (glomerular filtration rate less than 50 cc per minute), long loop and inadequate salt intake are among contributing factors. The syndrome is correctable by administration of salt. Some patients must be placed on salt supplement indefinitely. The jejunum is not recommended for urinary diversion in patients with limited renal function, those on low salt diet or those in whom a long intestinal loop would be required for diversion.