Downstream Complications Following Urinary Diversion

Abstract

Introduction

Surveillance following urinary diversion should be tailored to capture complications downstream from the initial reconstruction. Most analyses of the morbidity associated with urinary diversion are restricted to the index admission or the immediate postoperative period. We sought to characterize the long-term medical and surgical complications and burden of healthcare utilization following urinary diversion.

Methods

Using the 5% Medicare sample from 1998–2005 we identified individuals undergoing cutaneous and orthotopic continent urinary diversion, ileal conduit, or other type of diversions including enterocystoplasty from physician claims for the index admission. We restricted our sample to subjects with claims 1 year prior to surgery and at least 2 years after the diversion. We included benign and malignant primary diagnoses, and evaluated the incidence of medical and surgical complications 2 and 5 years after surgery. We stratified complications by diversion type, and compared long-term complications after urinary diversion surgery.

Results

Of 1,565 subjects identified, 80% underwent ileal conduit urinary diversion, 7% underwent cutaneous or orthotopic continent diversion, and 13% underwent other types of reconstruction. Urinary stone formation, wound complications and fistula complications were more common following continent diversion 5 years following surgery, while ureteral obstruction and renal failure/impairment were more common following ileal conduit diversion. Overall, we estimated that greater than 16% of patients experienced renal failure or impairment following urinary diversion.

Conclusion

Complications are common after urinary diversion and continue to occur through 5 years postoperatively. Urolithiasis and delayed wound complications appear to occur more commonly following continent diversion than after other urinary diversions. A large proportion of patients experience renal deterioration following diversion. These results highlight the need to survey patients for the diversion-related complications of cystectomy as rigorously as we monitor for cancer recurrence.