Conversion from colonic or ileal conduit to continent cutaneous urinary diversion.
OBJECTIVE
After ileal or colonic conduit diversion some patients, particularly adolescents, desire conversion to a continent diversion to improve quality of life. We report our long-term results on conversion from conduit diversion to continent cutaneous diversion.


METHODS
Between 1986 and 2001, 39 patients (mean age 24 years, range 6 to 49) underwent conversion from a colonic (21) or ileal conduit (18) to an ileocecal pouch (Mainz pouch I) with a mean followup of 102 months (range 18 to 192). Conversion was performed after a mean of 11 years (range 1 to 36) of conduit urinary diversion by incorporating the preexisting colonic/ ileal conduit and the ileocecal pouch.


RESULTS
A total of 21 patients (54%) experienced complications requiring surgical intervention including stoma stenosis (13%), pouch calculi (31%) and ureteral stenosis (6 of 75 renoureteral units, 8%). Continence was achieved in 95% of patients. Defecation was unchanged in 72% of patients without treatment. In 21% fecal frequency was medically controlled (cholestyramine, loperamide) and 8% of patients had fecal frequency. During followup early substitution of alkali was performed and in 19 patients (49%) the venous base excess was less than -2.5 mmol/l to prevent hyperchloremia and acidosis.


CONCLUSIONS
The inclusion of a preexisting colonic or ileal conduit decreases resection length of bowel for continent cutaneous diversion. Acceptable complication rates, stable renal function and satisfaction of patient expectations support conversion from a conduit into a Mainz pouch I as a safe and viable option in the long run.
Pahernik
Sascha
S
Department of Urology and Pediatric Urology, Johannes Gutenberg University, School of Medicine, Mainz, Germany. Pahernik@Urologie.Klinik.Uni-Mainz.de
Stein
Raimund
R
Hohenfellner
Markus
M
Thüroff
Joachim W
JW
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007223:Infant; D008297:Male; D008875:Middle Aged; D012867:Skin; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent