Conversion from colonic or ileal conduit to continent cutaneous urinary diversion.

Abstract

PURPOSE:

After ileal or colonic conduit diversion some patients, particularly adolescents, desire conversion to a continent diversion to improve quality of life. We report our long-term results on conversion from conduit diversion to continent cutaneous diversion.

MATERIALS AND METHODS:

Between 1986 and 2001, 39 patients (mean age 24 years, range 6 to 49) underwent conversion from a colonic (21) or ileal conduit (18) to an ileocecal pouch (Mainz pouch I) with a mean followup of 102 months (range 18 to 192). Conversion was performed after a mean of 11 years (range 1 to 36) of conduit urinary diversion by incorporating the preexisting colonic/ ileal conduit and the ileocecal pouch.

RESULTS:

A total of 21 patients (54%) experienced complications requiring surgical intervention including stoma stenosis (13%), pouch calculi (31%) and ureteral stenosis (6 of 75 renoureteral units, 8%). Continence was achieved in 95% of patients. Defecation was unchanged in 72% of patients without treatment. In 21% fecal frequency was medically controlled (cholestyramine, loperamide) and 8% of patients had fecal frequency. During followup early substitution of alkali was performed and in 19 patients (49%) the venous base excess was less than -2.5 mmol/l to prevent hyperchloremia and acidosis.

CONCLUSIONS:

The inclusion of a preexisting colonic or ileal conduit decreases resection length of bowel for continent cutaneous diversion. Acceptable complication rates, stable renal function and satisfaction of patient expectations support conversion from a conduit into a Mainz pouch I as a safe and viable option in the long run.

• Authors: Sascha Pahernik, Raimund Stein, Markus Hohenfellner, Joachim W Thüroff
• Journal: The Journal of urology (J Urol) Vol. 171 Issue 6 Pt 1 Pg. 2293-7 (Jun 2004) ISSN: 0022-5347 [Print] United States
• PMID: 15126806 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Colon (surgery)
• Female
• Follow-Up Studies
• Humans
• Ileum (surgery)
• Infant
• Male
• Middle Aged
• Skin
• Urinary Diversion (methods)
• Urinary Reservoirs, Continent