20-YEAR EXPERIENCE WITH JEJUNAL CONDUITS

Objectives, To assess the results of jejunal conduit: urinary diversio n, with particular attention to electrolyte imbalance and long-term re nal function. Methods, From 1976 to 1994, 50 patients underwent urinar y diversion using a short jejunal loop (10 to 12 cm) placed transperit oneally. Of these patients, 18 received pelvic irradiation before dive rsion. Renal function and configuration of the upper urinary tract wer e assessed by creatinine clearance and excretory urography. Results. M edian follow-up was 26 months (3 to 204). Of 50 patients, 22 had a fol low-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%), an d 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 w ith a follow-up of more than 5 years; however, of these patients, 2 ha d a decrease in creatinine clearance of greater than 20%, due to urete rojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurr ed and increased in I and 2 cases, respectively, and renal scarring oc curred and progressed in 2 and 2 cases, respectively. Conclusions, Uri nary diversion using a short length of jejunum placed transperitoneall y is a reliable procedure and gives good long-term renal function. Ele ctrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation. (C) 1997, Elsevier Science Inc. All rights reserved.