Ileal-conduit following cystectomy, single-institution revision of indications and outcome

OBJECTIVE: To revise indications, case fatality ratio, and postoperative early and late complications of ileal conduit as a method of urinary diversion.

METHODS: This is a retrospective study in which 200 patients underwent an ileal conduit from August 1994 to December 2000 in Mansoura Urology and Nephrology Center, Mansoura, Egypt. Preoperative criteria of patient selection, peroperative findings, and postoperative follow-up data were reviewed.

RESULTS: In 200 patients aged 29-75 years, with a mean age of 55.84 -/+ 8.91 years, the ileal conduit was chosen as a method of urinary diversion, due to one of the following patient or surgical factors; 50 (25%) cardiopulmonary co-morbidities, 27 (13.5%) liver cirrhosis, 20 (10%) impaired renal function, 18 (9%) poorly controlled diabetes mellitus, and 3 (1.5%) morbid obesity. Frozen section pathological examination showed carcinoma invasion of the urethra in 26 (13%), and prostate stroma in 16 (8%) male patients. Severe adhesions and difficult cystectomy were encountered in 25 (12.5%) patients. Tumor was found at or close to the bladder neck in 13 (6.5%) female patients, and 2 (1%) patients were found to have short mesentery. The mean follow up period was 90.02 -/+ 22.63 months. Fatality rate was 2%. Twenty-three (11.5%) patients had early complications, while 36 (23.7%) patients had late complications.

CONCLUSION: Ileal conduit is still the best urinary diversion method in many patients who have bladder cancer with associated chronic medical disease or certain surgical factors that render other urinary diversion methods more difficult, carry more postoperative morbidity and mortality, or both.