Abstract
Urinary diversion among patients receiving prior radiation is common. Herein, we present our experience with ileal conduit (IC) diversion in patients with a history of prior abdominal and/or pelvic radiation therapy. We analyzed the charts of 177 patients who underwent IC urinary diversion between 1/1994 and 6/2000, and 36 patients were identified who had previously undergone radiation therapy. Decisions to proceed were based on surgeon preference as determined by intraoperative appearance and viability of the selected bowel segment. Chart review included serum studies, upper tract imaging studies, and complications related to diversion. Durability of diversion was determined by examining the interval between urinary diversion and the need for additional procedures. A total of 30 patients with at least 3 months follow-up were identified. Renal function remained stable in 86% (26/30) with a median follow-up of 21.5 months (range 3–63 months). Hydronephrosis was noted preoperatively in 4 patients (13%) who demonstrated stable upper tracts and serum creatinine in the post-operative period. Three patients (10%) developed unilateral hydronephrosis related to tumor recurrence, with one patient demonstrating a rise in baseline serum creatinine. Hydronephrosis was noted in 5 patients (16%) secondary to development of ureteroenteric stricture. Serum creatinine remained stable in 2 patients without intervention with 2 years follow-up. Intervention for obstruction was necessary in 3 patients at 22, 31, and 61 months following diversion. In one patient, an intraoperative decision to use the colon for urinary diversion was made secondary to appearance of small bowel. Minor complications were noted in 9 patients (30%), while 3 patients (10%) experienced major complications in the immediate post-operative period. Five patients (17%) experienced complications potentially related to the use of ileum for urinary diversion. The use of ileum for urinary diversion among patients with a history of radiation appears technically feasible and a viable treatment alternative. Our data support the use of ileum in the majority of patients as evidence by a low complication rate and a high rate of upper tract preservation. In addition, these data imply that a prior history of abdominal and/or pelvic radiation should not serve as the sole determining factor in the selection of bowel segment utilized during urinary diversion.
Similar content being viewed by others
References
Ahlering TE, Kanellos A, Boyd SD et al. (1988) A comparative study of perioperative complications with Kock pouch urinary diversion in highly irradiated versus nonirradiated patients. J Urol 139:1202–1204
Alfert HJ, Gillenwater JY (1972) The consequences of ureteral irradiation with special reference to subsequent ureteral injury. J Urol 107:369–371
Beckley S, Wajsman J, Pontes JE, Murphy G (1982) Transverse colon conduit: a method of urinary diversion after pelvic irradiation. J Urol 128:464–468
Bochner BH, Figueroa AJ, Skinner EL et al. (1998) Salvage radical cystoprostatectomy and orthotopic urinary diversion following radiation failure. J Urol 160:29–33
Bricker E (1950) Bladder substitution after pelvic evisceration. Surg Clin North Am 30:1511–1521
Chang SS, Alberts GL, Cookson MS, Smith JA (2001) Radical cystectomy is safe in the elderly, high-risk patient. J Urol 166:938–941
DiMarco DS, LeRoy AJ, Thieling S et al. (2001) Long-term results of treatment for ureteroenteric strictures. Urology 58:909–913
Figueroa AJ, Stein JP, Dickinson M et al. (1998) Radical cystectomy for elderly patients with bladder carcinoma. Cancer 83:141–147
Gheiler EL, Wood DP, Montie JE, Pontes JE (1997) Orthotopic urinary diversion is a viable option in patients undergoing salvage cystoprostatectomy for recurrent prostate cancer after definitive radiation therapy. Urology 50:580–584
Harbach LB, Hall RL, Cockett AT et al. (1971) Ileal loop cutaneous urinary diversion: a critical review. J Urol 105:511–514
Lilien OM, Camey M (1984) 25-year experience with replacement of the human bladder (Camey procedure). J Urol 132:886–891
Malgieri JJ, Persky L (1978) Ileal loop in the treatment of radiation-treated pelvic malignancies: a comparative review. J Urol 120:32–34
Mannel RS, Braly PS, Buller RE (1990) Indiana pouch continent urinary reservoir in patients with previous pelvic irradiation. Obst Gynecol 75:891–893
Mannel RS, Manetta A, Buller RE et al. (1995) Use of ileocecal continent urinary reservoir in patients with previous pelvic irradiation. Gynecol Oncol 59:376–378
McDougal WS (1998) Use of intestinal segments and urinary diversion. In: Walsh PC, Retik AB, Vaughan ED et al. (eds) Campbell’s urology, vol. 3, 7th edn. Saunders, Philadelphia, pp 3149–3150
Morales P, Golimbu M (1975) Colonic urinary diversion: 10 years experience. J Urol 113:302–307
Paquin A, Marshall V (1956) Technique for radical cystectomy. In: A bladder tumor symposium. Lippincott, Philadelphia
Ravi R, Dewan AK, Pandey KK (1994) Transverse colon conduit urinary diversion in patients treated with high dose pelvic irradiation. BJU Int 73:51–54
Schmidt JD, Hawtrey CE, Flocks RH, Culp DA (1973) Complications, results and problems of ileal conduit diversions. J Urol 109:210–216
Schmidt JD, Hawtrey CE, Buchsbaum HJ (1975) Transverse colon conduit: a preferred method of urinary diversion for radiation-treated pelvic malignancies. J Urol 113:308-313
Skinner DG, Lieskovsky G, Boyd S (1989) Continent urinary diversion. J Urol 141:1323–1327
Wammack R, Wricke C, Hohenfellner R (2002) Long-term results of ileocecal continent urinary diversion in patients treated with and without previous pelvic irradiation. J Urol 167:2058–2062
Author information
Authors and Affiliations
Corresponding author
Additional information
Accepted for moderated presentation, AUA Annual Meeting, Orlando, May 2002.
Rights and permissions
About this article
Cite this article
Chang, S.S., Alberts, G.L., Smith, J.A. et al. Ileal conduit urinary diversion in patients with previous history of abdominal/pelvic irradiation. World J Urol 22, 272–276 (2004). https://doi.org/10.1007/s00345-004-0446-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-004-0446-4