Long-term effects of ileal conduit urinary diversion on upper urinary tract in bladder cancer.
OBJECTIVE
To evaluate the functional and morphologic changes of the upper urinary tract after radical cystectomy and ileal conduit urinary diversion for bladder cancer.


METHODS
Radical cystectomy and ileal conduit urinary diversion were performed in a total of 249 patients with bladder cancer at our hospital from 1980 to 1999. Of the 249 patients, 67 were excluded because of the presence of preoperative lesions in the upper urinary tract or elevated serum creatinine (greater than 1.4 mg/dL). Of the remaining 182 patients, 82 were also excluded because of incomplete follow-up or death less than 5 years after surgery.


RESULTS
Of the 249 patients, a total of 100 (40.2%) who had no preoperative lesions in upper urinary tract and normal renal function and survived 5 years or longer were included in this analysis. The median follow-up period was 91 months (range 60 to 193). The serum creatinine was greater than the normal range in 10 patients (10.0%), and radiologic changes in the upper urinary tract were observed in 14 patients (14.0%). They had diabetes mellitus nephropathy (4.0%) or specific comorbidities that could contribute to the deterioration of the upper urinary tract, such as ureteroileal anastomotic stricture (4.0%), chronic pyelonephritis (4.0%), urinary stones (1.0%), and upper urinary tract tumor (1.0%).


CONCLUSIONS
The results of our study have shown that the functional and morphologic changes in the upper urinary tract after radical cystectomy and ileal conduit urinary diversion occur in patients with specific comorbidities that could contribute to those changes. Different from previous reports, none of the upper urinary tract changes developed without an obvious cause.
Yang
Won Jae
WJ
Department of Urology, Inje University College of Medicine, Seoul, Korea.
Cho
Kang Su
KS
Rha
Koon Ho
KH
Lee
Hye Young
HY
Chung
Byung Ha
BH
Hong
Sung Joon
SJ
Yang
Seung Choul
SC
Choi
Young Deuk
YD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014513:Ureter / Q000473:pathology* / Q000503:physiopathology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods