Bladder drainage

For patients with bladder drainage, enteric conversion may be required for refractory problems, such as dehydration, metabolic acidosis, chronic urethritis caused by trypsinogen derivation, urinary tract infections, and recurrent reflux pancreatitis. This uivolves an anastomosis between the graft duodenal segment and the recipient small bowel. 

During the first months of life, the response to furosemide is often equivocal despite the absence of obstruction because of the low extraction (low clearance values). In the presence of a full bladder, drainage from the kidney maybe delayed even in the normal individual. 

The biliary system consists of the liver, the gall bladder and its associated drainage ducts which combine with the pancreatic duct to form the common bile duct. Situated in the upper right quadrant of the abdomen this is a highly vascular organ being perfused by... 

The peripheral effects concern the motility and tonus of gastrointestinal smooth muscle segmentation is enhanced but propulsive peristalsis is inhibited. The tonus of sphincter muscles is markedly raised (spastic constipation). The antidiarrhetic effect is used therapeutically (loperamide, p.180). Gastric emptying is delayed (pyloric spasm) and drainage of bile and pancreatic juice is impeded because the sphincter of Oddi contracts. Likewise, bladder function is affected specifically bladder emptying is impaired owing to an increased tone of the vesicular sphincter. 

The most obvious reason for a client post-TURP to be having lower abdominal pain is that the bladder has blood clots that need to be flushed out. Clots that are not flushed from the bladder result in bladder spasms. Assessing the urinary drainage would be the first step. 

The next step is to adjust the rate of the irrigation to ensure adequate drainage of blood and clots from the bladder. 

Retrograde lymphatic spread occurs in a similar way. The posterior portion of the prostate, the bladder base and the penis have the same lymphatic drainage into the external iliac nodes. This route of spread primarily brings metastases to the penile skin, rather than to the corpora or the glans. Arterial dissemination is uncommon. It can occur by direct tumor infiltration of arterial vessels, or by secondary tumor emboli originating from lung metastases. 

Catheters have a long history [1]. The earhest catheters were formed from straw and leaves and were used for drainage of urine. Hollow leaves of plants, coated with lacquer, were used as catheters in China around 100 BC. In 1036 AD Avicenna described the first flexible catheter made from stiffened animal skins. Benjamin Franklin designed a flexible silver catheter in 1752 for patients who suffered from bladder disease. The modem application of the catheter started in 1868 when a catheter with features for controlling the catheter insertion depth was patented by Dr N.B. Somborger. The modem disposable catheter was invented in the 1940s by David S. Sheridan [1]. 

There are no contraindications to IRC however, caution should be exercised in excluding VUR when there is dilatation with poor drainage of the upper tracts. Also in the presence of a pelvic kidney or a low ectopic kidney, the full bladder may obscure the kidney. 

Fig. 1.3.10. Value of postmicturition image series. Tc-99m MAG3 diuretic renogram with consecutive images over 20 min are shown. Both kidneys show prompt uptake of tracer with poor drainage by 20 min. The postmicturition image at 40 min (M) reveals little tracer in the renal pelvis on both sides. Note the bladder is also now empty. This was reflected in the curves and numerical analysis (PEE)...

Fig. 18.11. a Repair of bladder extrophy in a patient with a single left kidney. The patient developed subsequent hydronephrosis of the single kidney following surgery, b This required temporary nephrostomy drainage for relief of obstruction. There is narrowing of the distal ureter that resolved spontaneously... 

After birth it is essential to resuscitate the child when necessary, make urine drainage free, and destroy the valves. Follow-up in all patients should include yearly imaging using sonography to assess upper tract dilatation, drainage, and residual bladder volume. Renal functional imaging is also necessary. 

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