Which urinary diversion following radical cystectomy for muscle-invasive bladder cancer involves bringing both ureters to the skin as stomas (non-continent), and what is the major long-term metabolic complication of ileal conduit diversion?

• A Cutaneous ureterostomy; hypochloremic metabolic alkalosis
• B Indiana pouch; hypokalemic metabolic alkalosis
• C Ileal conduit (Bricker); hyperchloremic metabolic acidosis ✓
• D Studer neobladder; vitamin B12 deficiency and metabolic acidosis

Explanation

An ileal conduit (Bricker procedure) uses a 15–20 cm segment of ileum as a conduit; ureters are anastomosed to one end and the other end exits as a urostomy. The major metabolic complication is hyperchloremic metabolic acidosis, because the ileal mucosa absorbs ammonium chloride from urine in contact with it. The ileum also reabsorbs chloride in exchange for bicarbonate (normal ileal transport), leading to acidosis. Indiana pouch (colon reservoir) causes similar but less pronounced acidosis. Studer neobladder uses detubularized ileum; complications include B12 deficiency (terminal ileum used), metabolic acidosis, and urinary retention requiring self-catheterization.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.