Twenty-year experience with jejunal conduits

• Published in: Urology (Ridgewood, N.J.) N.J.), 1997-08, Vol.50 (2), p.207-213
• Main Authors: Fontaine, Eric, Barthelemy, Yvan, Houlgatte, Alain, Chartier, Eric, Beurton, Daniel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Female; Follow-Up Studies; Humans; Jejunum - surgery; Kidney Function Tests; Male; Medical sciences; Middle Aged; Postoperative Complications - epidemiology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Urinary Diversion - adverse effects; Urinary Tract - pathology; Urologic Diseases - physiopathology; Urologic Diseases - surgery; Water-Electrolyte Imbalance - epidemiology; Water-Electrolyte Imbalance - etiology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(97)00210-0

To assess the results of jejunal conduit urinary diversion, with particular attention to electrolyte imbalance and long-term renal function. From 1976 to 1994, 50 patients underwent urinary diversion using a short jejunal loop ( 10 to 12 cm) placed transperitoneally. Of these patients, 18 received pelvic irradiation before diversion. Renal function and configuration of the upper urinary tract were assessed by creatinine clearance and excretory urography. Median follow-up was 26 months (3 to 204). Of 50 patients, 22 had a follow-up more than 5 years later (median 86 months). Eight patients (16%) underwent 10 revision procedures postoperatively. Late complications related to urinary diversion included renal calculi (12%), parastomal hernia (6%), pyelonephritis (4%), ureterojejunal obstruction (4%), and stomal prolapse (2%). Electrolyte imbalance occurred in 2 patients (4%) and was easily corrected by 4 g sodium bicarbonate. No significant decrease in creatinine clearance (P = 0.6) was found in 22 patients with a follow-up of more than 5 years; however, of these patients, 2 had a decrease in creatinine clearance of greater than 20%, due to ureterojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurred and increased in 1 and 2 cases, respectively, and renal scarring occurred and progressed in 2 and 2 cases, respectively. Urinary diversion using a short length of jejunum placed transperitoneally is a reliable procedure and gives good long-term renal function. Electrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation.