Management of bowel and urinary tract complications after urinary diversion.

Fortunately, the incidence of serious bowel and conduit problems in the immediate postoperative period and within the first year after diversion is low (5 to 10 per cent). The ileal or colon conduit still serves as the standard method of urinary diversion in adults with pelvic malignancy. Prevention of these complications should truly begin in the preoperative period, and careful judgement should be used postoperatively so that no therapeutic option is undertaken too early. The goal in managing these complications is the preservation of renal function, the maintenance of longest possible amount of functioning bowel, and the absence of indwelling stents and tubes. Patience is needed, along with the maintenance of drainage, adequate nutrition, observation for and treatment of sepsis, and a careful delineation of the anatomic defects. These patients, with their high reoperative mortality rate (approximately 50 per cent), present one of the most intriguing and complicated challenges to the urologist. Using the principles outlined here, we have had only one death in 22 consecutive patients referred to the Lahey Clinic for the management of complex bowel and urinary tract complications following urinary diversion.