title: Late intestinal obstruction after radical cystectomy and urinary diversion: urological and oncological perspectives.
abstract: OBJECTIVE
  The aim of this study was to review different management modalities and outcome of patients presenting with late intestinal obstruction (IO) after radical cystectomy (RC) or palliative cystectomy (PC).
  
  
  METHODS
  Files of patients who presented with IO between January 1978 and June 2014 were reviewed. Patients who developed IO following either RC or PC more than 30 days after surgery were included. Patients' characteristics and management protocols were evaluated. Predictors for failure of conservative management and unfavorable outcome after surgical explorations were evaluated. Symptom-free and overall survival rates of patients with malignant IO was were recorded.
  
  
  RESULTS
  The prevalence of IO was 2.8% after RC (118 out of 4199 patients) and 10% after PC (nine out of 87). Colonic diversions had the highest prevalence (6.2%), followed by ileal loop conduit (2.9%); the lowest prevalences followed Kock pouch and ileal W neobladder (1.7% and 1.6%, respectively). Postoperative urinary leakage from a ureteroenteric anastomosis was the only predictor for surgical intervention (p = 0.039). Nine cases had been explored for malignant obstruction (eight after RC and one after PC). The mean ± SD elapsed time before death was 3.6 ± 2 months (range 0.5-17 months).
  
  
  CONCLUSIONS
  Urinary diversion with colonic segments carries more risk for the development of IO in comparison with ileal segments. Postoperative urinary leakage after cystectomy and urinary diversion may be a contributory factor for surgical exploration in cases with late IO.
authors: a Faculty of Medicine, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt.
authors: Ahmed S
authors: AS
authors: El-Hefnawy
authors: a Faculty of Medicine, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt.
authors: Tamer
authors: T
authors: Helmy
authors: a Faculty of Medicine, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt.
authors: Mahmoud
authors: M
authors: Laimon
authors: a Faculty of Medicine, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt.
authors: Samer
authors: S
authors: El-Halwagy
authors: a Faculty of Medicine, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt.
authors: Hassan
authors: H
authors: Abol-Enein
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D003106:Colon / Q000601:surgery; D000072700:Conservative Treatment; D015653:Cystectomy / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012086:Reoperation; D012189:Retrospective Studies; D019738:Surgically-Created Structures; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods
keywords: Bladder cancer; complication; diversion; intestinal obstruction; palliative cystectomy; radical cystectomy