NONSURGICAL MANAGEMENT STRATEGIES FOR THE FUNCTIONAL COMPLICATIONS OFILEOCOLONIC CONTINENT URINARY RESERVOIRS

Urinary diversion with creation of a continent ileocolonic reservoir w as performed in 25 patients with gynecological malignancies at our ins titution between September 1989 and September 1994. A retrospective re view was conducted and cases were analyzed for functional complication s associated with reservoir formation, Functional reservoir complicati ons were defined as (1) difficulty with catheterization, (2) reservoir fistulae, (3) reservoir stones, and (4) ureteral stenosis, Management strategies and outcomes for these complications were determined, All patients had received prior pelvic radiation therapy, There was no sur gical mortality, Median follow-up was 21 months, and 16 patients (64%) are currently alive, Fourteen of the patients (56%) had one or more c omplications attributable to a functional aspect of the continent rese rvoir. Two patients had difficulty with catheterization (8%), two pati ents had reservoir leak (8%), and one patient had reservoir stones (4% ). Nonsurgical management strategies were used in these cases includin g balloon dilation of the ileocecal valve, stomal dilation, ureteral s tenting, percutaneous nephrostomy, and endoscopic lithotripsy. All cas es of catheterization problems, reservoir fistulae, and reservoir ston es were resolved with nonoperative techniques. Thirteen of 50 ureters (26%) had some degree of stenosis, Percutaneous balloon dilation was u tilized in nine cases of ureteral stenosis. Relief of stenosis was com plete in five, partial in two, and not achieved in two of the cases, N o patients required a reoperation for a reservoir complication, In con clusion, continent ileocolonic urinary diversion can be performed in p atients previously treated with radiotherapy; however, functional rese rvoir problems may occur. Interventional radiology strategies are usef ul in managing many of these problems and reexploration can be success fully avoided. (C) 1995 Academic Press, Inc.