高雄長庚紀念醫院 外科部 泌尿科
Long term health effect of ileal conduit urinary diversion
Hao Lun Luo, Po Hui Chiang
Divisions of Urology, Department of Surgery, Kaohsiung Chang Gung Medical Center, Kaohsiung, Taiwan
Ileal conduit urinary diversion (ICUD) is the most common procedure after radical cystectomy. Distributions of potential complications have been reported, but there is not adequate number of patients with ICUD and bladder preservation control (transurethral resection of bladder tumor, TURBT) for long-term follow-up duration. The aim of this study is to compare the long-term health effect in patients who had undergone ICUD during long term observation.
Materials and Methods:
Data for this population-based cohort study were obtained from the Taiwan National Health Insurance Research Database (NHIRD). This study included 43,123 patients with diagnosis of bladder cancer between 1997 and 2006. Only cancer-free patients without chemotherapy and other types of urinary diversions and who lived for longer than five years were included for analysis. All enrolled subjects were followed-up until the end of 2011. The patients with bladder cancer underwent ICUD after radical cystectomy or TURBT only in this series.
Compared to the patients who had undergone bladder preservation procedure only, patients who had undergone ICUD after cystectomy were noted to be independently associated with postoperative de novo UTI, UTI with septicemia, and CKD (all the p<0.001, HR=1.49, 5.02 and 3.07 respectively). The limitations of this study are its retrospective and multicenter designs.
This study presents a nationwide cohort that ICUD after radical cystectomy may cause higher incidence of UTI, UTI with septicemia and CKD compared with TURBT only during long-term follow up.