Comparison of complications in three incontinent urinary diversions.
BACKGROUND
Few data are available in comparing different incontinent urinary diversions (ICUD).


OBJECTIVE
To compare early, short-term, and long-term complications in three different forms of ICUD.


METHODS
130 high-risk patients undergoing radical cystectomy and ICUD were prospectively enrolled at one institution. The patients were divided into three groups: ileal conduit (IC), colon conduit (CC), and ureteroureterocutaneostomy (UUCS).


METHODS
All patients underwent radical cystectomy and one form of ICUD.


METHODS
The complications observed were prospectively listed and subsequently compared. Statistical analysis was performed using the Pearson's chi-square test. A p-value < or = 0.05 was considered statistically significant.


CONCLUSIONS
130 patients with a median age of 71.0 yr (range 46-81) underwent radical cystoprostatectomy (RCP): n=95 (73%) or anterior pelvic exenteration (APE) n=35 (27%) with lymphadenectomy. An IC was performed in 55, a CC in 34, and a UUCS in 41 patients, respectively. A high comorbidity, mainly diabetes, arteriosclerosis, pulmonary insufficiency, and borderline renal function (creatinine>1.5mg%) was found in 12.7% of group 1, in 35.2% of group 2, and in 48.9% of group 3. Overall median follow-up was 16 mo (range 5-84). Perioperative mortality occurred in 1.5%. The overall perioperative diversion-unrelated complication rate was 23.6%. IC showed the lowest rate with 18.1%, followed by CC with 26.4%, and UUCS with 32%, respectively. In contrast, major diversion-related complications occurred in 18.1% of IC, in 5.8% of CC, and none in UUCS. The same was true for late surgical reintervention, with 20% for IC, 5.8% for CC, and 2.4% for UUCS.


CONCLUSIONS
Complications are closely related to the method selected. The IC had the highest rate of severe complications as well as surgical reinterventions and late complications in the intestinal tract.
Pycha
Armin
A
Department of Urology, General Hospital of Bolzano, L. Boehler Street 5, Bolzano, Italy. a_pycha@hotmail.com
Comploj
Evi
E
Martini
Thomas
T
Trenti
Emanuela
E
Mian
Christine
C
Lusuardi
Lukas
L
Lodde
Michele
M
Mian
Michael
M
Palermo
Salvatore
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D014519:Ureterostomy; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods*