Complication after ileal conduit done for urinary diversion post radical cystectomy

A 65-year-old lady underwent radical cystectomy for TCC bladder 1 year back.The surgery was uneventful.The mode of diversion was ileal conduit.The post-operative histopathology read as TCC T2N0.In the post-operative follow up she had recurrent UTIs and at the end of 1 year post-op her creatinine was around 2.3 mg%.

The imaging showed no local or systemic recurrence and the upper tracts showed changes of hydroureteronephrosis.The EC scan done to reveal the pattern of drainage didnot reveal any prolonged stagnation above uretero-ileal junction.During one such episode of UTI;we decided to put the catheter in the conduit for better drainage and then we realised that there was difficulty in catheterisation because of kinking at parietes.

We perfomed dynamic contrast study under fluoroscopic guidance; it showed adequate draiange.

With every episode of UTI she usually used to get elevated RFTs and the same used to settle down after the institution of the antibiotics and the conduit catheterisation.

We revised the stoma and the conduit was released from the parietes thinking that that would relieve the blockage but it didnot.After the stomal revision also she landed up again in UTI.

We went ahead and did percutaneous nephrostomy for her on both sides for the raised creatinine and the urosepsis.After the PCN her came down and got stabilised at 1.8 mg% and also she was free from UTI for 2 months period.The patient is still on bilateral indwelling PCNs and we are planning to go ahead with nephrostogram.If the nephrostomgram reveals any stagnation then the revision of the uretro-ileal junction will be needed.

The case was brought up here to discuss the long term complication of ileal conduit.The deterioration of kidney function,recurrent urosepsis,stomal complications are possible complications of ileal conduit diversion.