Incidence of cholelithiasis in 125 continent urinary diversions

Purpose: Several studies in animals and humans have demonstrated that ileal resection has an increased association with gallstone formation. However, little reported data exist in regard to continent diversion, and the incide nce and relative risk of gallstones. We describe a single institution, sing le surgeon (J. W. W.) experience with 125 modified Indiana pouch continent urinary diversions constructed in a 14-year period and the subsequent assoc iation with gallstones. Materials and Methods: We retrospectively reviewed the charts of 129 patien ts who underwent continent urinary diversion from March 1985 to August 1998 at our institution to assess postoperative cholelithiasis. Complete inform ation was available in 125 of the 129 charts. All patients were followed ye arly with ultrasound combined with telephone followup to ensure complete da ta. Results: Cholelithiasis was present in 32 of the 125 reviewable patients (2 5.6%), including 53 men and 72 women. Three men and 8 women who underwent p revious or concomitant cholecystectomy for gallstones were excluded from st udy. Therefore, cholelithiasis developed in 21 of the 114 remaining patient s (18.4%), including 5 males (4.3%) and 16 females (14%). Five of the 50 re maining men (10%) and 16 of the remaining 64 women (25%) had gallstones. Me an age at surgery was 43.5 years (range 19 to 73) and mean age at gallstone development was 45 years (range 23 to 77). Mean time from surgery to galls tone development was 3 years (range 1.1 to 5.5). Mean followup via chart re view was 41 months (range 1 to 127). The recent telephone followup reached 83 of the 125 patients (66.4%). However, 20 of the 42 patients who were not reached by the telephone followup had had clinic appointments at our insti tution in the last 11/2 years for an overall 82.4% followup rate (103 of 12 5 patients). Of the 21 patients with cholelithiasis 17 were identified by c hart review and 4 were identified by telephone followup. Conclusions: The recent literature indicates a 10% and 20% incidence of gal lstones in American men and women, respectively. Previous reports support a potential increase in cholelithiasis in patients who undergo ileal resecti on. Our data indicate no increased risk of gallstones in patients who under go modified Indiana pouch urinary diversion. However, longer followup is re quired to verify these findings.