Downstream complications following urinary diversion.

ABSTRACT

PURPOSE: Surveillance following urinary diversion should be tailored to capture complications downstream from the initial reconstruction. Most analyses of the morbidity associated with urinary diversion are restricted to the index admission or the immediate postoperative period. We characterize the long-term medical and surgical complications and burden of health care use after urinary diversion. MATERIALS AND METHODS: Using the 5% Medicare sample from 1998 to 2005 we identified individuals who underwent cutaneous and orthotopic continent urinary diversion, ileal conduit or other types of diversion including enterocystoplasty from physician claims for the index admission. We restricted our sample to subjects with claims 1 year before surgery and at least 2 years after the diversion. We included benign and malignant primary diagnoses, and evaluated the incidence of medical and surgical complications 2 and 5 years after surgery. We stratified complications by diversion type and compared long-term complications after urinary diversion surgery. RESULTS: Of the 1,565 subjects identified 80% underwent ileal conduit urinary diversion, 7% underwent cutaneous or orthotopic continent diversion and 13% underwent other types of reconstruction. Urinary stone formation, wound complications and fistula complications were more common following continent diversion 5 years after surgery, while ureteral obstruction and renal failure/impairment were more common after ileal conduit diversion. Overall we estimated that more than 16% of patients experienced renal failure or impairment after urinary diversion. CONCLUSIONS: Complications are common after urinary diversion and continue to occur through 5 years postoperatively. Urolithiasis and delayed wound complications appear to occur more commonly after continent diversion than after other urinary diversions. A large proportion of patients experience renal deterioration after diversion. These results highlight the need to survey patients for the diversion related complications of cystectomy as rigorously as we monitor for cancer recurrence.