(Bricker Ileal Conduit)

Description

• Ileal conduit (first developed in the 1940’s) is a neo-bladder created from a detached section of ileum
  • Ureters are re-anastomosed to the neo-bladder
  • Neo-bladder empties via stoma through abdominal wall -> bag is emptied every 1-2 days (to decrease risk of infection)

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Indications for Ileal Conduit

• Radical Cystectomy (for bladder cancer): ureters are anastomosed to the ileal neo-bladder
• Renal Transplantation: in some cases, ureters from renal transplant are anastomosed to ileal neo-bladder to isolate the transplant from a native refluxing bladder
  • As ostomies are frequently colonized with bacteria, there is a higher risk of infection of transplanted organ in these cases

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Complications of Ileal Conduit

• A total of 47 major complications requiring admission or surgery occurred in 36 patients (36%). These complications included bowel obstructions, stomal issues, pyelonephritis, ureteroileal strictures, renal insufficiency, and stones. An elevation in serum creatinine above the normal range was seen in 10 patients (10%) – four of these patients eventually progressed to renal failure requiring dialysis – and radiologic changes to the upper urinary tract occurred in 14 patients (14%). These patients had diabetes mellitus nephropathy (4%- all of the renal failure patients requiring dialysis) or specific co-morbidities that could contribute to the deterioration of the upper urinary tract, such as ureteroileal anastomotic strictures (4%), chronic pyelonephritis (4%), urinary stones (1%) and upper urinary tract tumor (1%).
• Despite the upper tract changes seen in this series, the authors point out that all patients with issues had specific co-morbidities that could predict upper tract damage and no patient developed upper tract changes without an obvious cause. This differs from previous reports that suggest that such changes may be inevitable despite the absence of co-morbidities outlined here.
  [Urology Volume 68, Issue 2 , August 2006, Pages 324-327]

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• Early Complications of Ileal Conduit

  • Urinary leakage
  • Lymphatic leakage
  • Ileus

• Late Complications of Ileal Conduit (after 6 wks)

  • Recurrent UTI
  • Parastomal hernia
  • Ureteric strictures – probably ischaemic
  • Stomal infarction – ischaemic
  • Stomal retraction
  • Stomal stricture
  • Metabolic Acidosis (see [[Metabolic Acidosis-Normal Anion Gap]])
  • Bilateral hydronephrosis
  • Renal stone

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References

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