Supravesical diversion for incontinence: a long-term follow-up.

OBJECTIVES

To report the long-term follow-up of patients with an ileal conduit urinary diversion, constructed for intractable incontinence in patients with benign disease where the native bladder was left in situ, and to determine the fate of the bladder and the effects on the upper tracts.

PATIENTS AND METHODS

Ninety-three patients (mean age at operation 50 years, range 8-78) were followed for a minimum of 2 (mean 5) years after undergoing an ileal conduit urinary diversion. Seventy-one patients (76%) had neurological disease (18 traumatic and 53 non-traumatic) and the single largest group of patients (28) suffered from disseminated sclerosis. Twenty-two patients with no obvious neurological disease underwent the procedure for unmanageable incontinence or intractable bladder symptoms or for interstitial cystitis. The patients were assessed for problems in the bladder remnant, stomal problems and upper tract changes following surgery.

RESULTS

Forty-eight patients (52%) had recurrent vesical infections and pyocystis and of these, 23 (48%) required admission for in-patient bladder irrigations. To control recurrent bladder problems, five patients required creation of a vesico-vaginal fistula; this did not suffice in two and they subsequently underwent cystectomy; in total, five patients underwent cystectomy. Twenty-nine patients (31%) had stomal problems, those with the skin being commonest. Parastomal hernia repair was required in 10 (10%) patients and three had further surgery for recurrence. Of 83 patients with normal upper tracts before diversion, post-operative radiological assessment showed upper tract dilatation in 28 (34%) and in 10 (12%) this was bilateral. In one patient with a neuropathic bladder, the ileal diversion resulted regression of the dilated upper tracts.

CONCLUSIONS

Supravesical diversion is safe and well tolerated but assessing the long-term follow-up, the incidence of bladder problems in over half these patients and upper tract changes in over a third suggests an indefinite follow-up is mandatory. Despite these problems, most patients are delighted with the outcome of their surgery.