title: Long-term complications of conduit urinary diversion.
abstract: OBJECTIVE
  We evaluated long-term surgical complications and clinical outcomes in a large group of patients treated with conduit urinary diversion.
  
  
  METHODS
  We identified 1,057 patients who underwent radical cystectomy with conduit urinary diversion using ileum or colon at our institution from 1980 to 1998 with complete followup information. Patients were followed for long-term clinical outcomes and analyzed for the incidence of diversion specific complications.
  
  
  RESULTS
  A total of 844 patients died at a median of 4.1 years (range 0.1 to 28.1) following cystectomy. Median followup of the surviving 213 patients was 15.5 years (range 0.3 to 29.1). There were 643 (60.8%) patients with 1,453 complications directly attributable to the urinary diversion performed with a mean of 2.3 complications per patient. Bowel complications were the most common, occurring in 215 patients (20.3%), followed by renal complications in 213 (20.2%), infectious complications in 174 (16.5%), stomal complications in 163 (15.4%) and urolithiasis in 162 (15.3%). The least common were metabolic abnormalities, which occurred in 135 patients (12.8%), and structural complications, which occurred in 122 (11.5%). Increasing age at cystectomy (HR 1.21, p <0.001), increasing Eastern Cooperative Oncology Group performance status (HR 1.23, p = 0.02) and recent era of surgery (HR 1.68, p <0.001) were significantly associated with a higher incidence of complications.
  
  
  CONCLUSIONS
  Conduit urinary diversion is associated with a high overall complication rate but a low reoperation rate. Long-term followup of these patients is necessary to closely monitor for potential complications from the urinary diversion that can occur decades later.
authors.affiliation: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA. shimko.mark@mayo.edu
authors.forename: Mark S
authors.initials: MS
authors.lastname: Shimko
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
authors.forename: Eric C
authors.initials: EC
authors.lastname: Umbreit
authors.forename: Sara A
authors.initials: SA
authors.lastname: Farmer
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects