Following an ileal conduit urinary diversion a client voices several concerns

The information presented here supplements an article in The Journal of Urology, “Long-term complications of conduit urinary diversion” (April 2009 Vol. 181, Issue 4, Supplement, Page 266).

Authors

Mark Shimko M.D., Matthew Tollefson M.D., Eric Umbreit M.D., Sara Farmer, Michael Blute, M.D. and Igor Frank, M.D., from the Department of Urology (MSS, MKT, ECU, MLB, IF) and Health Sciences Research (SAF), Mayo Medical School and Mayo Clinic, Rochester, Minn.*

* There are no financial disclosures for this manuscript or any author.

Condensed Abstract

A review of long-term complications from conduit urinary diversion is presented. This is the largest series on conduit urinary diversion complications to date and enables more informed operative decisions regarding urinary reconstruction during cystectomy as well as potential long-term follow up considerations.

Purpose

To evaluate long-term surgical complications and clinical outcomes in a large group of patients treated with conduit urinary diversion.

Materials and Methods

We identified 1057 patients who underwent radical cystectomy with a conduit urinary diversion using either ileum or colon at our institution from 1980-1998 with complete follow up information. Patients were followed for long-term clinical outcomes and analyzed for the incidence of diversion-specific complications.

Results

844 patients had died at a median of 4.1 (range 0.1-28.1) years following cystectomy. Median follow-up in the surviving 213 patients was 15.5 (0.3-29.1) years. 643 (60.8%) patients experienced 1453 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 patients (20.2%), infectious complications in 174 patients (16.5%), stomal complications in 163 patients (15.4%), and urolithiasis in 162 patients (15.3%). The least common were metabolic abnormalities, which occurred in 135 patients (12.8%), and structural complications, which occurred in 122 patients (11.5%). Increasing age at time of cystectomy (HR 1.21, p<0.001), increasing ECOG status (HR 1.23, p=0.02), and recent era of surgery (HR 1.68, p<0.001) were significantly associated a higher incidence of complications.

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  Complications of Conduit Diversion

Conclusions

Conduit urinary diversion is associated with a high overall complication rate but a low reoperation rate. Long-term follow up of these patients is necessary to closely monitor for potential complications from their urinary diversion which can occur decades later.

An ileal conduit (IC) is the most common urinary diversion performed by urologists after a patient undergoes a radical cystectomy (bladder removal). It is a simple form of urinary tract reconstruction that uses the ileum as an alternative pathway for urine to exit the body. The IC does not store urine. It is a way to remove urine from the body.

How is an ileal conduit created?

After a radical cystectomy, a urinary diversion allows urine to leave your body. To create an ileal conduit:

• One end of a short segment of the small intestine (which has been removed from the rest of the intestine) is connected to a stoma that is created in the abdomen. Since a stoma does not contain any nerve endings, it is not painful.
• The ureters, which normally carry urine from the kidneys to the bladder, are attached to the other end of the segment of intestine.
• Urine travels from the ureters into the newly formed ileal conduit, through the stoma and out of the body.
• An ostomy appliance is placed over the stoma.
• This appliance consists of an adhesive skin barrier (wafer), which sticks to the skin surrounding the stoma and a pouch or bag that attaches to the skin barrier. This bag collects the urine and is worn outside the body. There is a twist valve at the bottom of the bag to conveniently drain urine as the appliance fills.

Before surgery

A portion of your intestines will be used to create the urinary diversion. Your surgeon will provide you specific instructions to prepare your intestine for your cystectomy. Ask your doctor about any special preparations you should follow before your surgery. These can include:

• Medication or herbal supplements you should avoid or stop taking
• Food and drink limitations
• Talk to your ostomy nurse. He or she can:
  • Help you decide where you want the stoma to be. When you decide where you want your stoma to be, think about how it will affect what you can wear.
  • Teach you how to change the bag and clean the skin around it.
  • Give you advice on what ostomy supplies you might want to try.

Maintenance/Living with a Ileal Conduit/Urostomy Pouch

The ileal conduit urinary diversion takes the least amount of time in surgery and uses the least amount of small intestine. Many patients have a faster recovery than with other diversion options. With proper care, you can avoid a lot of problems.

• Surgery can cause swelling, so the size of your stoma will shrink as you recover after the surgery. As you recover, make sure your ostomy supplies still fit.
• Make sure your clothing is comfortable. After you heal, most people are able to wear the same clothing they wore before
• their surgery.
• Leaks will still happen sometimes. Keep extra supplies in your car, at work, and when you travel, in case you need to change your bag.
• Once your stoma heals, if you notice bulging that is uncomfortable or makes it difficult to secure your ostomy appliance, speak to your urologists.
• Talk to your ostomy nurse if you have issues with leakage or irritation with your bag.
• Maintaining your ileal conduit will become a routine part of your everyday life.
• A urinary tract infection (UTI) can occur. Watch for stronger smelling, cloudy, darker urine or blood in your urine. A UTI may also cause lower back pain. Contact your urologist if you suspect you have a UTI.

Watch ostomy nurse Jocelyn Goffney, CWOCN, discuss the Care and Keeping of an Ileal Conduit with BCAN patient advocates Darrell Nakagawa, and Anne Marie Theriault in the webinar.

Patient story

Listen to this uplifting and frank conversation with bladder cancer patient Vicki S. who considers herself to be the “luckiest ileal conduit person in the world.”

What are complications of ileal conduit?

Which is a complication that may occur after urinary diversion surgery?

What are the complications of urinary diversion?

What happens after an ileal conduit surgery?