Urinary diversion

StudyStudy type and ELNo. of patientsPatient characteristicsInterventionLength of follow-upOutcome measuresEffect sizeAdditional comments
Singh 1997537
UK study
Case series
EL = 3
93 (63% F)M/F mean age 50 (8–78) years who underwent ileal conduit urinary diversion
76% had neurological disease, 24% unmanageable UI or intractable symptoms of interstitial cystitis
ileal conduit urinary diversionMinimum 2 years (mean 5)Complications52% vesical infection and pyocystis; reqd hospitalisation in 48% for bladder irrigation. 5/48 had vesico-vaginal fistula
None had carcinoma in residual bladder
31% stoma problems, most minor (skin reactions, infections). None reqd physician intervention
11% parastomal hernia requiring surgery
33% upper tract dilatation (44% vs 27% of pts with > 5 vs < 5 years follow-up)
Funding: none declared.
Retrospective review of case notes (1 surgeon’s patients).
Cox 1987538Case series
EL = 3
18F mean age 54 (38–63) stress UI (3 also had bladder instability)Ileal loop diversionMinimum 1 yearComplications (n)Complications related to dysfunctional bladder:
10 vaginal discharge
3 pyocystits
[8 reqd vesicovaginal fistula 12–18 months (mean 18) after 1st procedure: all eventually underwent cystectomy]
8 underwent total of 14 revision operations on loops/stomas (3 for obstruction, 2 each: peristomal hernia, persistent excoriation, persistent leakage, stoma too long, self-inflicted stoma damage, 1 stomal stenosis
1 septicaemia
1 stomatitis (later had uterosigmoidostomy)
Funding: none declared.
Retrospective review of case notes (1 surgeon’s patients).

From: Evidence tables for included studies

Cover of Urinary Incontinence
Urinary Incontinence: The Management of Urinary Incontinence in Women.
NICE Clinical Guidelines, No. 40.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2006 Oct.
Copyright © 2006, National Collaborating Centre for Women’s and Children’s Health.

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