Laparoscopy-Assisted Ileal Conduit Diversion for Intractable Hematuria from Radiation Cystitis

Abstract

Background and Purpose: Intractable hematuria from radiation-induced hemorrhagic cystitis is a difficult clinical problem to manage. Despite treatment with cystodiathermy, bladder washout, multiple transfusions and even hyperbaric oxygen therapy, urinary diversion with ileal conduit formation may be a last resort life saving measure. To decrease the morbidity of this procedure, minimally invasive laparoscopic techniques can be employed to mobilize and prepare both ureters. We present two cases of laparoscopy-assisted ileal conduit urinary diversion which were performed for intractable hematuria secondary to radiation cystitis. Case Reports: Two elderly males aged 76 and 78, developed intractable hematuria after having had radical radiation therapy previously for localized prostate cancer. Laparoscopy-assisted ileal conduit formation was done. The ureters were located at the bifurcation of the iliac vessels, mobilized and divided near the uretero-vesical junction. The left ureter was tunneled under the sigmoid mesocolon towards the right lower abdomen. By making a 6cm muscle splitting abdominal incision joining the right 5 and 10mm ports, the ureters and a segment of the ileum were externalized. The ileal conduit including the enteroenterostomy and the bilateral ureteroenterostomy was done extra-corporally. The operating time was 3.5 and 5.5 hours for the first and second case respectively. At 6 months post-operatively, both patients were well with no recurrence of hematuria or urosepsis. Conclusion: Laparoscopy-assisted ileal conduit diversion in this initial experience was associated with acceptable operative time and minimal post-operative morbidity. It may serve as a reasonable minimally invasive alternative to conventional open ileal conduit diversion.