Comparison of complications in three incontinent urinary diversions.

Abstract

Few data are available in comparing different incontinent urinary diversions (ICUD). To compare early, short-term, and long-term complications in three different forms of ICUD. 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). All patients underwent radical cystectomy and one form of ICUD. 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. 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. 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.