The incidence of pyocystis following ileal conduit urinary diversion for benign aetiology and subsequent requirement for remnant bladder cystectomy
BAUS ePoster online library. Barratt R. Jun 27, 2018; 211403
Ms. Rachel Barratt
Ms. Rachel Barratt
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Abstract
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Introduction: Pyocystis of a remnant bladder following ileal conduit urinary diversion can be difficult to treat conservatively and often requires remnant bladder cystectomy. We sought to assess the incidence, risk factors and need for subsequent cystectomy in patients with pyocystis of defunctionalised bladders following ileal conduit urinary diversion for benign causes..

Patients and Methods: Patients undergoing ileal conduit urinary diversion (benign aetiology) over a 17 year period (1997-2004) were identified and records analysed. Data retrieved included patient demographics and co-morbidities, indications for urinary diversion, development and treatment of pyocystis and the need for subsequent cystectomy. Mean age was 46 years (range 2-78) and mean follow-up 49 months (range 6-252 months).

Results: 66 (81%) female and 15 (19%) male patients were included in the analysis. Indications for conduit formation included: end-stage complex urinary incontinence, bladder pain syndrome, atonic bladder and Fowler's syndrome. Treatment options utilised for patients with pyocystis included: antibiotics, remnant bladder intermittent self-catheterisation, remnant bladder washout and simple cystectomy. Risk factors for pyocystis and the incidence of cystectomy are detailed in Table 1. 18 patients with pyocystis (95%, p<0.01) required eventual cystectomy. The remaining patient with pyocystis was not medically fit for further surgery. There were no correlations between aetiology and subsequent development of pyocystis.

Conclusion: Following ileal conduit diversion for benign aetiology 24% of patients developed pyocystis. Conservative treatments have been shown to be ineffective in this cohort and 95% require simple cystectomy. This study suggests male gender and prior SPC insertion may be risk factors for developing pyocystis.
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