Diagnosis and treatment of ileal conduit urinary diversion stomal varicose bleeding / 中华泌尿外科杂志

Objective To improve the understanding of ileal conduit urinary diversion stomal varicose bleeding.Methods 3 male cases of ileal conduit urinary diversion stomal varicose bleeding were reported.The pathogenic mechanism,clinical features,diagnosis and treatment of this disease were reviewed and discussed with the relevant literature review.The ages were 59,45 and 68.All of them had ileal conduit urinary diversion because of muscle invasive bladder cancer.Ileal conduit urinary diversion stomal varicose bleeding were found at 6 years,6 months and 2 months after surgery.The bleeding was intermittent.All the stomal varicose were found in physical examination.The laboratory examinations showed abnormities of liver functions in all three cases.Image studies showed one with liver metastasis and two with liver cirrhosis.Portal venous hypertension was considered as the cause of bleeding.Results We controlled the bleeding by suturing the first patient's varicose.The patient was died 3 months later because of the advanced cancer.For the second patient,we controlled the bleeding by compressing the varicose.By the meantime,we reduced the portal venous hypertension with medication.The stomal varicose bleeding stopped when the liver function and the portal venous hypertension improved 2 months later.The third patient's stomal varicose were injected with sclerosants.There was no mnore stomal varicose bleeding within half-year follow-up.Conclusions Ileal conduit urinary diversion stomal varicose bleeding is usually found in the patients who have portal venous hypertension because of liver cirrhosis or liver metastasis.To control the bleeding,we can decrease the patient's portal venous hypertension.To control hemorrhage,we can use suturing,compressing,and sclerotherapy,which is an optional treatment.

Postoperative Complications of Ileal Conduit Urinary Diversion / 대한비뇨기과학회지

Continent urinary diversion or neobladder has been attempted more and more recently. However, ileal conduit urinary diversion is still the most common diversion technique applied after cystectomy, because it is much simpler than other techniques and also because it has reportedly produced less postoperative complications. But there have not been enough long term follow-up reports on this procedure in Korea. Therefore, the authors followed 90 ileal conduit urinary diversion cases which were performed at the Korea Cancer Center Hospital(KCCH) between 1985 and 1994. Upon these 90 cases, the authors analyzed the occurrence of early complications and late complications in percentage. For the early complications, wound complications comprised 16%, early intestinal obstruction 2%, necrosis of ileal segment .1%, leakage of ureteroileal anastomosis 2% and acute pyelonephritis comprised 4%. These statistics show similar result with other reports. For the late complications, stromal stenosis comprised 1% and the formation of calculi 3%. These number are lower occurrence compared to other reports. Also, the late postoperative ileus comprised 10% and renal deterioration 12%. These reflect similar occurrences with other reports. In conclusion, reviewing long term follow-up on ileal conduit urinary diversion by means of analyzing the early and late complications, the ileal conduit urinary diversion is still considered good diversion technique which has acceptable ratio of renal deterioration and postoperative complications.