Perioperative care protocols for a canine model of a new gastrocolonic pouch for continent urinary diversion.

Traditionally, in continent urinary diversion (CUD), the ileum, ascending colon, or sigmoid colon is utilized to construct a urinary reservoir with a continence mechanism. When CUD was performed in women who had undergone extensive pelvic irradiation therapy for gynecologic cancer, the complication rate was exceedingly high due to the poor vascularity of the irradiated bowel incorporated in the reservoir. In order to avoid this very high complication rate, an animal study was conducted to test the feasibility of constructing a CUD utilizing nonradiated stomach, transverse colon, and proximal ureters. The development of this model in the canine necessitated prolonged abdominal surgery involving both the gastrointestinal and urinary systems. The immediate postoperative challenge included the need for continuous intravenous fluid infusion, maintenance of patent renal stents and neobladder stomal catheters, prevention of hypothermia and hypokalemia, and reduction of postoperative discomfort. Re-establishing an adequate plane of nutrition, preventing colonic ulceration from gastric secretions in the pouch, monitoring renal function, maintaining a patent stoma during healing, and managing the gradual expansion of the pouch were among the chronic care considerations. This procedure required the institution of unique and intensive perioperative care protocols. Using the methods discussed in this paper, three of four dogs in a pilot study survived the procedure and were included in an ongoing study of the new gastrocolonic continent urinary diversion.