Long-term Complications of Conduit Diversion

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.

  • Complications of Conduit Diversion
    Complications of Conduit Diversion
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.

Table

Complications of Conduit Diversion

For more information, please contact the corresponding author:
Mark Shimko, M.D.
200 First Street SW
Rochester, MN 55905
Phone: 507-284-3982
Fax: 507-284-4951
shimko.mark@mayo.edu