Aims of study:
Ileal
conduit urinary diversion for intractable urinary incontinence is
a treatment of last resort. There are however a group of patients
where this procedure represents the best option to provide long
term urinary storage. We wished to review and report the clinical
experience of this treatment over an 11 year peroid at 1 institution.
Methods:
A retrospective notes
review was undertaken of those patients who had received ileal conduit
urinary diversion for urinary incontinence since the appointment
of one the authors to the post of Consultant Urologist at a District
General Hospital in the UK in 1988. The study population was sub-divided
into 3 groups: patients who had chronic inflammatory cystitis (Grp
1), bladder dysfunction secondary to a diagnosable neurological
disorder (Grp 2) and severe incontinence of unknown aetiology (Grp
3).
Results:
A total of 34 patients were identified for study,
the details of which are shown below.
|
|
Group 1
|
Group 2
|
Group 3
|
|
Number
Mean age at diversion (yrs)
Median T. from presentation to referral (mths)
Median T from referral to diversion (mths)
Median T with catheter drainage (months)
Mean survival with conduit (months)
|
9
69.4
10
13
N/A
81.4
|
16
54
19
41
22
50.3
|
9
42.7
12
44.5
36
70.9
|
Early (<30days) and late postoperative complications
were seen overall in 29% and 61% of patents respectively. The re-operation rate was 42.4%. Stomal problems were exclusively seen in Grp
3, with all but one patient suffering stomal related morbidity. The total condition related mortality was 15%.
Conclusions:
Ileal conduit urinary diversion successfully provides
long term relief of urinary incontinence in a highly selected group
of debilitated patients. The treatment is associated with a high re-operation
rate and so rightly should be considered 'last resort'. There is a sub-group of female patients, with
bladder failure of obscure aetiology, who suffer a high rate of
stomal morbidity.
