Ureteral Diversion (Ureterosigmoidostomy)
What is Ureteral Diversion (Ureterosigmoidostomy)?
Ureteral diversion is a surgical procedure that redirects urine flow when the bladder has been removed or bypassed. In ureterosigmoidostomy, surgeons connect the ureters directly to the sigmoid colon. This allows urine to exit the body through the rectum along with stool.
This procedure was more common decades ago but is rarely performed today. It was typically done after bladder removal for cancer or severe bladder dysfunction. Modern surgeons usually prefer other methods that create separate urinary pathways. However, some people still live with ureterosigmoidostomy from past surgeries.
When urine mixes with the colon lining, it creates predictable metabolic changes. The colon absorbs substances from urine that normally leave the body. This can lead to chemical imbalances in the blood that require regular monitoring through blood tests.
Symptoms
- Frequent watery bowel movements that contain urine
- Difficulty controlling bowel movements or urinary leakage
- Fatigue and weakness from metabolic imbalances
- Rapid or deep breathing as the body tries to balance acid levels
- Confusion or difficulty concentrating in severe cases
- Increased thirst and dehydration
- Abdominal cramping or discomfort
- Recurrent urinary tract infections
- Weight loss or poor appetite
Some people with well-functioning diversions may have minimal symptoms for years. However, metabolic complications can develop silently and worsen over time without regular monitoring.
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Causes and risk factors
Ureterosigmoidostomy is performed as a surgical solution after bladder removal, most commonly for bladder cancer. Other reasons include severe birth defects of the bladder, traumatic bladder injury, or chronic conditions causing irreparable bladder damage. The procedure itself is the cause of the metabolic complications that follow.
When urine contacts the colon lining, the body reabsorbs chloride from the urine back into the bloodstream. At the same time, the colon secretes bicarbonate into the urine-stool mixture. This exchange creates high chloride levels and low bicarbonate levels in the blood. The result is a condition called hyperchloremic metabolic acidosis, where the blood becomes too acidic. Risk factors for more severe complications include longer segments of colon exposed to urine, decreased kidney function, dehydration, and infections.
How it's diagnosed
Diagnosis begins with a medical history and physical examination to understand surgical history and current symptoms. Blood tests are essential for monitoring metabolic complications. Chloride levels help identify the characteristic electrolyte imbalance that occurs when urine contacts the colon. Elevated chloride combined with low bicarbonate confirms hyperchloremic metabolic acidosis.
Additional tests may include kidney function panels, complete blood counts, and urine cultures to check for infections. Imaging studies like CT scans or ultrasounds evaluate the surgical connection and check for blockages or kidney problems. At Rite Aid, you can get tested for chloride and other biomarkers that monitor metabolic health after ureteral diversion. Regular blood testing helps catch complications early before they cause serious symptoms.
Treatment options
- Oral sodium bicarbonate supplements to neutralize excess acid in the blood
- Potassium citrate to help restore acid-base balance
- Increased fluid intake to prevent dehydration and reduce chloride reabsorption
- Regular bowel movements to minimize contact time between urine and colon
- Low-chloride diet in some cases, though dietary changes alone rarely solve the problem
- Antibiotics for urinary tract infections
- Regular blood testing every 3 to 6 months to monitor electrolyte levels
- Surgical revision to a different type of urinary diversion if metabolic problems become severe
Treatment focuses on preventing and managing metabolic acidosis rather than curing it. Most people with ureterosigmoidostomy need lifelong monitoring. Work closely with your urologist and primary care doctor to adjust treatments based on blood test results and symptoms.
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Frequently asked questions
Ureterosigmoidostomy is a surgical procedure that connects the ureters to the sigmoid colon, allowing urine to exit through the rectum. It was historically performed after bladder removal for cancer or severe bladder damage. Modern surgeons rarely use this technique today, preferring other urinary diversion methods that separate urine from the digestive tract.
Hyperchloremic metabolic acidosis is a chemical imbalance where blood becomes too acidic due to high chloride and low bicarbonate levels. It occurs in ureterosigmoidostomy because the colon absorbs chloride from urine while secreting bicarbonate. This predictable complication requires regular monitoring and often needs medication to correct.
Most doctors recommend blood testing every 3 to 6 months to monitor chloride and other electrolyte levels. More frequent testing may be needed if you have symptoms, kidney problems, or difficulty controlling acidosis with medication. Regular monitoring helps catch complications before they become severe.
Many people adapt to life with ureterosigmoidostomy, though it requires adjustments. You will have combined urine and stool output, which can be socially challenging. Regular medication and blood testing are usually necessary. Quality of life varies widely depending on how well the diversion functions and how effectively metabolic complications are managed.
Long-term risks include chronic metabolic acidosis, recurrent urinary tract infections, kidney damage, and electrolyte imbalances. There is also an increased risk of colon cancer at the surgical connection site after many years. Regular colonoscopy screening is recommended starting about 10 years after surgery.
Chloride testing detects the characteristic electrolyte imbalance caused by urine contact with the colon. Elevated chloride levels indicate that the colon is reabsorbing too much chloride from urine. This helps doctors diagnose metabolic acidosis early and adjust medication doses to prevent complications.
Diet alone rarely corrects the metabolic problems from ureterosigmoidostomy. Drinking plenty of fluids helps reduce chloride reabsorption by keeping urine diluted. Some doctors may recommend reducing dietary chloride, but most people still need medication. Focus on staying hydrated and following your treatment plan.
Seek urgent testing if you experience severe fatigue, confusion, rapid deep breathing, or extreme weakness. These symptoms may indicate severe metabolic acidosis requiring immediate treatment. Persistent vomiting, inability to take oral medications, or signs of dehydration also warrant prompt medical attention and blood work.
The metabolic complications cannot be fully cured as long as urine contacts the colon. Treatment manages the problem but does not eliminate it. If acidosis becomes uncontrollable despite maximum medication, surgical revision to a different type of urinary diversion may be considered. Most people manage well with medication and monitoring.
Yes, surgeons can convert ureterosigmoidostomy to other urinary diversion types. Options include ileal conduit, which creates a separate opening for urine, or continent urinary reservoirs. These alternatives prevent urine from contacting the colon and resolve metabolic complications. Discuss options with your urologist if your current diversion is not working well.