Use of Gastrointestinal Segment in Urinary Diversion

Chong, Ce lI; Yoon, Jin Han

Abstract

We have studied general patient characteristics, the early and late postoperative complications associated with each procedure and the results of urodynamic studies in 29 patients who had received various kinds of urinary diversion at the Dept. of Urology, Dong-A University Hospital from May 1990 to May l994. The results are as follows. 1. Of 29 urinary diversions, ileal conduit was performed in 18 patients, appendicoureterocutaneostomy in 2, Indiana pouch in 8 and rectal pouch in l. The surgical indications were bladder tumor in 28 and pelvic actinomycosis in 1 2. Sex ratio between male and female was 22:7. Average age according to each procedure was 67,4 years old in ileal conduit group, 62.5 years old in appendicoureterocutaneostomy, 54.3 years old in lndiana pouch, and 33.0 years old in rectal pouch. Average operative time ranged from 275.5 to 647.5 minutes. with lndiana pouch group taking maximum time and appendicoureterocutaneostomy group taking the least time. 3. There was no change in postoperative renal function and serum electrolytes. Concerning the period of hospital stay, ileal conduit in 21.3 days, Indiana pouch group was 28.7 and appendicoureterocutaneostomy in 20.5 days being the shortest of all. 4. Wound infection was most common early postoperative complication occurring in 5 out of 29 patients. Anastomotic leakage was seen in 2 out of 18 ileal conduits, 2 paralytic ileus in ilea1 conduit and lndiana pouch each. 5. Six months postoperative cystometric studies show the average volume and average reservoir pressure of 533.3ml and 22.7cmH2O in lndiana pouch and 38.0cmH2O in rectal pouch which is greater than the maximum intraluminal pressure. In conclusion, the author believes that the urologic surgeon should be familiar with several procedures, because these procedures should be tailored to the patient's anatomy, prior surgery, renal function and preference.