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64 - 02-13
Indications And Complications In Patients Undergoing Ileal Conduit After Radical Cystectomy

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Indications and Complications in Patients Undergoing Ileal Conduit After Radical Cystectomy

Daniel Artenstein BA, Matt Ashley MD, Anne Schuckman MD, Hooman Djaladat MD, Gus Miranda BS, Siamak Daneshmand MD

Background

•Choice of urinary diversion following radical cystectomy (RC) is a complex decision between patient and surgeon
•Medical and social factors are taken into account when choosing ileal conduit diversion (IC) versus continent urinary diversion (CUD)
•Decreased postoperative complications and more expeditious surgery are reasons commonly cited to perform an IC
•The purpose of the study is to examine the indications for an IC in patients undergoing RC at our institution and to present their complications

Methods

•317 patients underwent RC with IC at USC by multiple surgeons
•From January 2003-December 2013
•150 patients (47%) randomly selected
•Retrospective review of perioperative data, indication for IC and complications graded with Clavien-Dindo Classification (CDC)
•Major complication is CDC>=3
•Early complications (0-30 days), late complications (31+ days)

Results

•18% of IC by choice, 82% had medical or functional contraindication
•Most common complications: urinary tract infection (21.3%), dehydration (19.3%) and superficial wound dehiscence in (12%)
•Perioperative mortality (within 30 days or on same admission) was 4%
•12% of patients had a diversion specific complication, most commonly parastomal hernia
•66% of patients with diversion specific complication required major intervention, most commonly PCNT and surgical stomal hernia repair

Conclusion

•Patient choice accounts for only 18% of all IC procedures at our institution. All others had a medical or social contraindication
•12% of patients undergoing IC had a diversion related complication, two thirds requiring major intervention
•Thorough preoperative counseling and medical evaluation are the key to selecting appropriate urinary diversion following RC