Fate of the leftover bladder after supravesical urinary diversion for benign disease.
OBJECTIVE
We studied the fate of the leftover bladder in patients who underwent supravesical urinary diversion without cystectomy for benign pathology.


METHODS
This retrospective study was performed in 9 males and 15 females with a median age of 59 years in whom supravesical urinary diversion was performed for various benign conditions from 1996 to 2004. These conditions were incontinence, acontractile bladder, radiation and/or hemorrhagic cystitis, and neuropathic bladder. Median followup was 48 months.


RESULTS
Of the patients 13 (54%) experienced problems with the retained bladder, 2 (8%) presented with urethral bleeding, which resolved by conservative means, and 11 (46%) had infective complications, which resolved with expectant treatment in 3 (12%). However, 8 patients (33%) had frank pyocystis and 3 (12%) were treated with the Spence procedure, which alleviated symptoms in only 1. Six patients (25%) required cystectomy.


CONCLUSIONS
In patients undergoing supravesical urinary diversion for benign disease in whom the bladder remains in situ the risks of complications related to the defunctionalized bladder are more than 50% and 25% of patients subsequently need cystectomy. These patients should be offered primary cystectomy at urinary diversion.
Fazili
Tajammul
T
Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK. tajfazili@hotmail.com
Bhat
Tahir R
TR
Masood
Shikohe
S
Palmer
John H
JH
Mufti
G R
GR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods*