Ileal Neobladder Substitution (ileal bladder) (4 of 9)

A close up of the uretero-enteric anastomosis. Ureterosigmoidostomy was the first widely used surgical approach for urinary diversion after cystectomy. The ureters were implanted into the sigmoid colon and the anal sphincters were relied upon to provide continence. Approximately 50 years of experience with this approach defined a series of complications that guided subsequent surgical progress: Gradual deterioration of renal function, secondary both to chronic urinary tract infection, which was a result of mixing of the urinary and fecal streams, and to obstruction of the ureterointestinal anastomosis Hyperchloremic acidosis, as a result of resorption of excreted urinary products by the bowel mucosa Development of secondary cancers in the sigmoid colon near the site of ureteral implantation.