Endoscopy of ileal conduit with ureteral instrumentation

A case is presented in which endoscopy was used to perform retrograde catheterization with drainage of a pyonephrosis followed by stone basket manipulation in a patient with ileal conduit. The technique is described and recommended for access to the upper urinary tracts in the patient with an ileal conduit.     

Late malignant change in an ileal conduit

Abstract:   Around 3000 bowel segment transpositions are performed in the UK each year and although malignancy is well-recognized following ureterosigmoidostomy, reports of similar changes in ileal conduits are sparse. We report a case of ileal adenocarcinoma in a 67-year-old lady some 49 years after ileal conduit, demonstrating previously unassociated histopathological features similar to those seen in collagenous colitis.     

Biopsy of ureteral tumor in patient with ileal conduit

A patient with ileal conduit and recent dilation of the left upper collecting system had flexible fiberoptic endoscopy of the ileal loop. The entire lumen of the intestinal conduit and the ureteroileal anastomosis were visualized. In addition retrograde pyelography and direct vision biopsy of a tumor in the ureter were performed.     

Case report: Knotted ureteral stent in patient with ileal conduit: Conservative approach for retrieval

A 70-year-old woman with an ileal conduit developed stones in both kidneys and the right ureter. A Double-J stent was placed to facilitate treatment of the stone on the right side. After nearly complete clearance on the right side, an attempt to retrieve the stent was unsuccessful because of a knot at the proximal end that was impacted at the ureteroilial anastomotic site. We describe removal of this impacted knotted stent with a conservative approach.     

A “bridge” technique to replace the obstructed single-J stent in the patient with ileal conduit urinary diversion: a case report

The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn’t be inserted through the primary ureteral stent. We used our “bridge” technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this “bridge” technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.     

Lethal complications of standard self-retaining ureteral stents in patients with ileal conduit urinary diversion

While standard commercially available pigtail ureteral stents are used commonly in the obstructed patient, particularly when metastatic disease has been identified, our recent experience suggests caution in the use of such stents for patients with ileal conduits. Rapid obstruction of these stents occurs with unacceptable frequency, which has resulted in urosepsis and death, and they do not appear to be cost-effective even for palliation. Although these standard pigtail stents have physical properties that allow easy placement by angiographic wire guidance, they are not to be recommended. Safe internal ureteral diversion in patients with an ileal conduit awaits further evolution in stent technology.     

Bricker's ileal conduit urinary diversion with a simple non-refluxing uretero ileal anastomosis

Fifty consecutive patients had ileal conduits constructed with a technically and quick simple antireflux ureteroileal anastomosis. Complications related to the ureteral implantation were studied retrospectively, and at follow-up (8 months-12 years later, median 3 years) conduit dysfunction and ureteral reflux were assessed in 18 patients out of the 25 patients who were still alive. Early complications and signs of late upper urinary tract deterioration were similar to those found after other operative techniques had been used. One patient had a postoperative urinary leak from the uretero ileal anastomosis. which was treated successfully by two weeks drainage. Hydronephrosis deteriorated in 18 (26%) of the renal units, remained unchanged in 39 (57%) and improved in 11 (16%). Increases in plasma creatinine concentrations up to 200 mumol/l were found in eight patients, and in one patient it increased from 300 to 420 mumol/l. Partial ureteral reflux was present in three (2 patients) of 33 ureters studied and minimal conduit dysfunction was found in 8 patients. In conclusion we find this method of urinary diversion to be quick, easy, and safe.     

Simplified technique with short and long-term followup of conversion of an ileal conduit to an Indiana pouch

PURPOSE: We report a simplified technique for converting an existing conduit to an Indiana pouch as well as short and long-term results. MATERIALS AND METHODS: From May 1988 to February 1998 we evaluated short and long-term outcome and complications in 23 patients 14 to 82 years old (average age 51.8) who underwent conversion of a conduit to an Indiana pouch. When no obstruction of the existing ureteroileal anastomoses was identified, the conduit was freed from the abdominal wall and surrounding bowel. The proximal conduit and ureteral anastomoses were not dissected. The conduit was opened along the antimesenteric wall proximal to the ureteral anastomoses and attached to 25 to 28 cm. of detubularized right colon as a refluxing Studer limb. The pouch was completed in the usual fashion and the stoma was matured at a virgin site. RESULTS: Surgical indications included stomal complications in 10 patients, an infected nonfunctioning kidney in 2 and patient preference in 11. There were no perioperative deaths although 3 patients died of cancer progression. Average operative time was 6.6 hours, estimated blood loss 518 cc and length of stay 7.8 days. Average followup after conversion was 4.7 years (range 0.2 to 11.0). Six late complications developed in 4 cases, including pyelonephritis in 2, severe pouchitis in 1, dehydration in 1 and stomal revision in 2. Renal function was well preserved with an average preoperative and postoperative creatinine of 0.91 and 1.14 mg./dl., respectively. CONCLUSIONS: This technique simplifies conversion and decreases bowel requirements. The low complication rate and stable serum creatinine support the finding that conversion of a conduit to an Indiana pouch is a safe, viable procedure.     

Outcome of deceased donor renal transplantation in patients with an ileal conduit

Renal transplantation in recipients with an ileal conduit is uncommon and occasionally controversial as it has been associated with high morbidity and mortality rates. We report on 17 patients with an ileal conduit who received a deceased donor renal transplant at our institution between January 1986 and December 2012. We retrospectively reviewed their allograft and surgical outcome. There were four mortalities at five, five, 39, and 66 months post‐transplant. Sixteen of 17 grafts functioned immediately; one patient had primary non‐function secondary to vascular thrombosis. Thirteen of 17 (76.5%) grafts were functioning at a mean follow‐up period of 105 months. The mean serum creatinine at follow‐up was 111 μM (±38.62). Five patients had seven episodes of urosepsis requiring hospital admission, and five patients received treatment for renal stone disease. We conclude that given improvements in immunosuppression, surgical technique, infection treatment, and selection criteria, we believe that renal transplantation in the patient with an ileal conduit yields excellent graft survival, although there is a high morbidity rate in this cohort of patients in the long term.     

Urinary undiversion in 35 patients with neurogenic bladder and an ileal conduit

Urinary undiversion was performed in 21 male and 14 female patients with neurogenic bladder and an ileal conduit urinary diversion, 3-17 years after the original operation. Twenty-six patients had surgery for ileal conduit complications but nine had an elective undiversion. In 24 patients, reconstruction was achieved by ureteroureteric anastomoses, in six by ureteroneocystotomy and in five by primary enterocystoplasty. Transureteroureterostomy (TUU) was an essential part of almost all the reconstructive procedures. Secondary operations were necessary in 10 patients, seven of whom had an enterocystoplasty. Improvement or stabilization of the upper urinary tract was eventually achieved in all patients. Twelve male patients void normally with complete urinary control in eleven and incontinence in one. Eight male and all 14 female patients are managed by clean intermittent catheterization (CIC) with complete urinary control in 12, acceptable dampness in eight and incontinence in two. One male patient is managed by an indwelling urethral catheter. All patients showed an improved physical and emotional status and preferred life without a urinary stoma. Urinary undiversion should be considered in all patients with ileal conduit complications and in selected patients with an uncomplicated ileal conduit.     

Continent vesicostomy with an ileal conduit. A case report

A patient is described who had construction of a vesicocutaneous ileal conduit with a continent intussusception valve allowing for intermittent self-catheterisation. The procedure was performed on a 13-year-old male patient with a normal bladder but with a totally unreconstructable urethra as a result of previous traumatic urethral disruption and unsuccessful urethral alignment procedures.     

Two cases of patients with renal transplants presenting with anuria due to an infarcted ileal conduit

Transplanting kidneys into patients with an ileal conduit has become acceptable practice, and is usually well tolerated. We present the cases of two such patients who later presented as emergencies with anuria due to infarction of the ileal conduit. Both required operative intervention, and in both cases the renal function returned to its pre-operative level. The cases illustrate an important differential diagnosis of anuria in this group of transplant patients.