Modified Technique to Prevent Complications Related to Stoma and Ileoureteral Anastomosis in Patients Undergoing Ileal Conduit Diversion

• Published in: Urology (Ridgewood, N.J.) N.J.), 2010-10, Vol.76 (4), p.996-1000
• Main Authors: Zhang, Zhi Ling, Liu, Zhuo Wei, Zhou, Fang Jian, Li, Yong Hong, Xiong, Yong Hong, Rao, Kai, Hou, Guo Liang, Han, Hui, Qin, Zi Ke, Yu, Shao Long, Chen, Xiao Feng
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Biological and medical sciences; Carcinoma, Transitional Cell - surgery; Cystectomy; Female; Hernia, Abdominal - prevention & control; Humans; Ileum - surgery; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Postoperative Complications - prevention & control; Risk Factors; Surgical Stomas - adverse effects; Suture Techniques; Urethra - surgery; Urinary Bladder Neoplasms - surgery; Urinary Diversion - methods; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2009.09.086

Objectives To introduce a modified technique for preventing complications related to stoma and ileoureteral anastomosis in patients undergoing ileal conduit diversion. Methods A urinary stoma was created intracorporeally and was pulled out to the abdominal wall through a retroperitoneal tunnel. The ileal conduit was fixed by nonabsorbable sutures that incorporated all abdominal wall fascia and the bowel seromuscular layer. The terminal ureter was spatulated and anastomosed to the conduit in an end-to-side fashion by a continuous lock-stitch suture after stoma maturation and conduit fixation. A 24F multiorifice catheter was introduced into the ileal conduit as a stent, but a ureteral stent was not used. The peritoneum underlying the stoma was preserved intact, and the ureters and the conduit were completely extraperitonealized. A urine collection device was attached to the matured stoma immediately after surgery. Results The modified technique was used in 56 consecutive patients who underwent ileal conduit diversions. The median operative time was 327 minutes. No early complications, such as urine or intestinal leakage, occurred. Two patients, however, developed ileus. The median follow-up was 36 months. Forty-five patients survived disease-free, whereas 11 died during the follow-up. There were no stoma-related complications or stenosis at the ileoureteral anastomotic site. No metabolic complications were observed and renal function was normal in all patients. Conclusions Complications related to stoma and ileoureteral anastomosis in patients undergoing ileal conduit diversion can be prevented using our modified technique. However, further clinical investigation is required to confirm the advantage and long-term effects of our modified technique.