Long-Term Complications of Conduit Urinary Diversion

Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
The Journal of urology (Impact Factor: 4.47). 02/2011; 185(2):562-7. DOI: 10.1016/j.juro.2010.09.096
Source: PubMed


We evaluated long-term surgical complications and clinical outcomes in a large group of patients treated with conduit urinary diversion.
We identified 1,057 patients who underwent radical cystectomy with conduit urinary diversion using ileum or colon at our institution from 1980 to 1998 with complete followup information. Patients were followed for long-term clinical outcomes and analyzed for the incidence of diversion specific complications.
A total of 844 patients died at a median of 4.1 years (range 0.1 to 28.1) following cystectomy. Median followup of the surviving 213 patients was 15.5 years (range 0.3 to 29.1). There were 643 (60.8%) patients with 1,453 complications directly attributable to the urinary diversion performed with a mean of 2.3 complications per patient. Bowel complications were the most common, occurring in 215 patients (20.3%), followed by renal complications in 213 (20.2%), infectious complications in 174 (16.5%), stomal complications in 163 (15.4%) and urolithiasis in 162 (15.3%). The least common were metabolic abnormalities, which occurred in 135 patients (12.8%), and structural complications, which occurred in 122 (11.5%). Increasing age at cystectomy (HR 1.21, p <0.001), increasing Eastern Cooperative Oncology Group performance status (HR 1.23, p = 0.02) and recent era of surgery (HR 1.68, p <0.001) were significantly associated with a higher incidence of complications.
Conduit urinary diversion is associated with a high overall complication rate but a low reoperation rate. Long-term followup of these patients is necessary to closely monitor for potential complications from the urinary diversion that can occur decades later.

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    • "The strengths of the present study are that PSH was defined and graded according to modern classifications and that an examination that has previously been demonstrated to correspond to findings at a CT scan in the prone position was used [26]. Also, the time to follow-up was accurate in finding most cases of PSH, although some may develop nearly 20 years after the surgery [5]. However, there are limitations to address. "
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    ABSTRACT: Objective: There are no data on the frequency of parastomal hernia (PSH) after ileal conduit with a prophylactic mesh. The primary objective of this study was to determine the prevalence of PSH. Secondary objectives were to elaborate whether age, gender, body mass index (BMI), previous laparotomy or diabetes influenced the outcome; and to find any mesh-related complications. Materials and methods: In a single centre during 2003-2012, a large-pore, lightweight mesh was placed in a sublay position in 114 consecutive patients with ileal conduits. Preoperative and postoperative patient data were retrospectively collected and cross-sectional follow-up was conducted. During the predefined clinical examination a PSH was defined as any protrusion in the vicinity of the ostomy with the patient straining in both an erect and a supine position. Results: Fifty-eight patients (24 women and 34 men, mean age 69 years) had follow-up examinations after a mean of 35 months (median 32 months). Bladder cancer was the most common cause for surgery. Eight patients (14%) had a PSH. Age, gender, BMI, previous laparotomy and diabetes did not affect the outcome. No mesh-related complications occurred among the 114 patients with a prophylactic mesh. Conclusions: The prevalence of PSH after ileal conduit with a prophylactic mesh corresponded to that of colostomies with a prophylactic mesh. A prophylactic mesh did not seem to be associated with complications. The degree to which a prophylactic mesh may reduce the rate of PSH after an ileal conduit should be established in randomized trials.
    No preview · Article · Feb 2015 · Scandinavian Journal of Urology
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    • "Still, an ileal conduit is blemished with its own set of complications. The various complications manifest at different times, and these patients require close surveillance for even decades after the urinary diversion [2]. One of the long term complications noted after urinary diversion is urolithiasis and the incidence varies from 4.9% to 15.3% [3]. "
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    ABSTRACT: Calculus formation in an ileal conduit following cystectomy is a known complication. Encrustation and formation of calculus may also occur over a DJ stent retained for a long period; but this is never reported in patients with conduit diversion because of close surveillance of these patients. Here we report first case of a large calculus encrusted over a forgotten DJ stent within an ileal conduit in a man who had undergone urinary diversion following radical cystectomy for carcinoma urinary bladder 8 years earlier
    Full-text · Article · Aug 2014
    • "In addition, patients with multiple medical co-morbidities are often recommended for a conduit diversion only if the procedure is performed with short operative time. This makes unbiased comparisons between these reconstructions difficult and should be considered whenever comparing complications of different reconstructive options.[8] "
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    ABSTRACT: There are few reports describing series of cases about development on laparoscopic urinary diversions no related to cystectomy. The aim of this paper is to show the experience of our reference institutions for treatment of pelvic malignancies when laparoscopic techniques were applied to perform only urinary diversion without cystectomy or pelvic exenteration. We included retrospectively 12 cases of cutaneous ureterostomy and 21 cases with a reservoir (16 ileal conduits, 2 colonic conduits and 3 wet colostomies) treated in our institute from 2004 to 2010. It was evaluated operative time, blood loss, intraoperative complications, conversion rate, length of large incision, post operative complications, analgesic consumption, time to food intake, hospital stay, time to recovery to normal activities. Mean time to follow-up was 3(2-7) years. All procedures were completed without conversions. In the cutaneous ureterostomy group the mean surgical time.
    No preview · Article · Mar 2013 · Journal of Minimal Access Surgery
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