Abstract

In a series of 150 ileal conduits a standardized methodical operative technique reduced complications to an acceptably low level. Intravenous pyelographic evidence obtained before and after conduit diversion indicates that when the upper urinary tract is normal at the time of diversion, 90% remain normal, but 10% will deteriorate subsequently; and when the upper urinary tract is abnormal at the time of diversion, only 15% are improved, so that the conduit does not frequently reverse the changes in the upper tract, and the patient remains at renal risk. The presence of urinary infection in a conduit is fallacious if assessed by specimens obtained by a single catheter into the stoma; a double catheter is required, with urine collected via an inner catheter passed into the depths of the segment through an outer protecting sleeve. Conduitograms contribute little to routine follow-up, but are important in defining obstructive complications in the segment, at the stoma, and at the uretero-ileal anastomosis. As the prognosis after diversion is considerably better when diversion is performed in a normal upper tract, the age of diversion should be chosen as a time before any objective signs of deterioration have commenced. In myelomeningocele patients a practical compromise satisfying this criterion is 2 yr of age.

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