Ileal Conduit Surgery Health Article

Morbidity and mortality rates

Possible complications associated with ileal conduit surgery include bowel obstruction, blood clots, urinary tract infection, pneumonia, skin breakdown around the stoma, stenosis of the stoma, and damage to the upper urinary tract by reflux. Pyelonephritis, or bacterial infection of a kidney, occurs both in the early postoperative period and over the long term. Approximately 12% of patients diverted with ileal conduits and 13% in those diverted with anti-refluxing colon conduits have this complication. Pyelonephritis is associated with significant mortality.

Alternatives

An alternative to ileal conduit surgery is continent surgery in which a neo-bladder is fashioned from bowel segments, allowing the patient to evacuate the urine and avoid having an external appliance. The procedures of continent diversion are more complicated, require more hospitalization, and have higher complication rates than conduit surgery. Many patients, unable to manage a stoma, are good candidates for continent diversion.

BOOKS

Walsh, P., et al. Campbell's Urology, 8th Edition. St. Louis: Elsevier, 2000.

PERIODICALS

Estape, R., L. E. Mendez, R. Angioli, and M. Penalver. "Gynecologic Oncology: Urinary Diversion in Gynecological Oncology." Surgical Clinics of North America 81, no. 4 (August 2002).

ORGANIZATIONS

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. <www.niddk.nih.gov>.

United Ostomy Association, Inc. (UOA). 19772 MacArthur Blvd., Suite 200, Irvine, CA 92612-2405. (800) 826-0826. <www.uoa.org.>.

OTHER

"Urinary Diversion." American Urological Association. <www.urologyhealth.org.>.

Nancy McKenzie, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Surgery is performed by a urological surgeon who specializes in urinary diversion. It is performed in a general hospital.

QUESTIONS TO ASK THE DOCTOR

• How soon after the surgery will I be taught how to use an ostomy?
• Will the ostomy be obvious to others?
• Is continent surgery, or surgery with an internal neo-bladder, a better alternative?
• How do conduit and continent surgery compare in terms of recuperation, complications, and quality-of-life issues?