CPT® Code 50810

1. Indications

Ureterosigmoidostomy is performed for several specific medical conditions that necessitate urinary diversion. The following are the primary indications for this procedure:

• Bladder Cancer - Patients diagnosed with bladder cancer may require this procedure to divert urine when the bladder is compromised or removed.
• Neurogenic Bladder - Individuals with neurogenic bladder, a condition where nerve damage affects bladder control, may benefit from ureterosigmoidostomy to manage urinary function.
• Radiation Injury to the Bladder - Patients who have sustained radiation damage to the bladder may need this surgical intervention to bypass the injured area.
• Intractable Incontinence - Those suffering from severe incontinence that cannot be managed through conservative treatments may require this procedure to establish a new method of urine elimination.
• Other Conditions - Additional conditions that impair bladder function and warrant urinary diversion may also be indications for ureterosigmoidostomy.

2. Procedure

The ureterosigmoidostomy procedure involves several critical steps to ensure successful urinary diversion. The following outlines the procedural steps:

• Step 1: Incision and Access - The procedure begins with a midline incision in the abdomen, allowing the surgeon to access the peritoneal cavity. The peritoneum is opened to facilitate further surgical steps.
• Step 2: Isolation of the Small Bowel - The small bowel is isolated and temporarily packed out of the surgical field to provide a clear view of the ureters, which are essential for the subsequent steps.
• Step 3: Exposure and Division of Ureters - The ureters are carefully exposed, mobilized, and divided distally near the ureterovesical junction. The ureteral stumps are then ligated to prevent any urine flow during the procedure.
• Step 4: Mobilization of Sigmoid Colon - A segment of the sigmoid colon is selected and mobilized for the construction of the new bladder. This segment is isolated to prepare for the anastomosis.
• Step 5: Division and Anastomosis of Sigmoid Colon - The sigmoid colon is divided, and an appropriately sized segment is isolated. The remaining distal and proximal portions of the sigmoid colon are anastomosed to restore bowel continuity.
• Step 6: Creation of Sigmoid Bladder - The sigmoid bladder is fashioned from the isolated segment of the sigmoid colon, which will serve as the new reservoir for urine.
• Step 7: Tunnel Creation and Ureteral Anastomosis - A tunnel is created from the sigmoid bladder to the ureters. The ureters are pulled through this tunnel and into the lumen of the sigmoid. The ends of the ureters are spatulated along the anterior aspect, and they are anastomosed to the sigmoid colon approximately 3 cm apart.
• Step 8: Stoma Creation - A separate abdominal or perineal incision is made to create a stoma through which urine will be expelled. The sigmoid bladder is exteriorized through this stoma, folded back on itself (everted), and sutured to the skin or subcutaneous tissue, forming either an abdominal or perineal colostomy.
• Step 9: Securing the Ostomy - An ostomy bag is secured over the sigmoidostomy site, or alternatively, a catheter may be placed in the stoma to facilitate urine drainage.
• Step 10: Closure - Drains are placed as needed, and the surgical incisions are closed in layers to ensure proper healing and minimize complications.

3. Post-Procedure

After the ureterosigmoidostomy procedure, patients will require careful monitoring and post-operative care. Expected recovery includes managing the stoma and ensuring proper function of the newly created sigmoid bladder. Patients may need education on stoma care, including how to change the ostomy bag and monitor for any signs of complications such as infection or obstruction. Follow-up appointments will be necessary to assess the function of the urinary diversion and to address any concerns that may arise during the recovery process. Additionally, patients should be informed about potential dietary adjustments and the importance of hydration to support urinary health.