ABSTRACT
Objectives: After ileal or colon conduit diversion some patients; in particular in adolescence; desire a conversion into a continent form of diversion thus removing external devices and improving the quality of life. We report our long-term results of conversion from conduits into a continent cutaneous diversion. Methods: Between July 1986 and February 2001; a total of 32 patients (mean age: 18 years; range 6 to 49 years) underwent conversion of a colon (n=19) or ileal conduit (n=13) into an ileo-caecal pouch with a mean follow-up of 97 months (range 11-185 months). Conversion was performed using a simplified technique incorporating the preexisting colon/ileal conduit into ileocaecal Mainz pouch I. The morphology of the upper urinary tract; renal function; con-tinence and metabolic changes were analyzed. Results: A total of 17 patients (53) showed complications requiring surgical intervention; these included stoma stenosis (13); pouch calculi (28) as well as ureteric stenosis in 4/61 RU (7). Continence was achieved in 97of patients. Faecal frequency was unchanged in 75of patients without treatment while the rest required medical therapy (cholestyramine; loperamide). During follow-up; early substitution of alkalizing agents was performed at a base excess of -2.0 mmol/l for 15 patients (47); thus preventing acidosis. The renal function remained stable during follow-up. All patients are completely satisfied; in particular as compared to the previous situation. Conclusion: The inclusion of the preexisting colon or ileal conduit facilitates continent cutaneous conversion and decreases bowel requirements. An acceptable complication rate; a stable renal function and the patient's comfort support the conversion of a conduit into Mainz Pouch I as a safe and viable option on the long run
Subject(s)
Urinary Diversion , Urinary TractABSTRACT
Objective Urinary diversion after pelvic irradiation is challenging. The use of irradiated bowel is mostly complicated and unsuccessful. Therefore; the use of an exclusively non-irradiated bowel segment; such as the transverse colon; is a good alternative in such situation. Patients and Methods Twenty-nine female patients who had received a high dose of irradiation underwent construction of a transverse colon reservoir as a primary form of urinary diversion. The indications were irreparable vesicovaginal fistula in 5; local recurrence of gynaecological tumors in 18 and invasive bladder carcinoma in 6 patients. They were followed up for a median of 5.6 (1-9) years. Results No pouch-related complications were observed. Hydronephrosis improved in 9 of 15 renal units that had preoperatively been dilated. Incontinence occurred in 3 patients due to an inefficient stoma that was revised; and all were continent thereafter. Conclusion The results suggest that the transverse colon reservoir in previously irradiated patients is safe and effective. It can; therefore; be recommended as the method of choice in this group of patients