Skip to main content

Advertisement

SpringerLink
Log in

Renal function in the setting of urinary diversion

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Incorporating bowel into the urinary tract sets the stage for a potentially dangerous situation for the upper part of this tract. Obstruction, reflux and chronic bacteriuria may develop, all of which can all be detrimental. Most reports on renal function have used IVP and serum creatinine only, methods which are inadequate for proper assessment. Long-term follow-up of patients with ileal conduit diversion reveals a high incidence of morphological and/or functional damage to the kidneys. Refluxing techniques for implanting the ureters have usually been employed. In patients with continent cutaneous diversion or orthotopic bladder substitution, some recent publications have shown rather well preserved glomerular filtration rates. Traditionally, antirefluxing ureteric implantation has been used in these patients. There is presently a trend towards refluxing anastomosis in this setting, providing a low pressure pouch has been constructed. However, pressure can be high in such pouches and bacteriuria is common. The consequences for the fate of the upper urinary tract is unknown and caution should be exercised in recommending such techniques. There is clearly a need for prospective randomized controlled studies on the issue of refluxing versus antirefluxing anastomosis in continent urinary reconstruction. Patients with continent or non-continent diversion should have lifelong follow-up with regard to the upper urinary tract.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abol-Enein H, Ghoneim MA (1994) A novel uretero-ileal reimplantation technique: the serous lined extramural tunnel. A preliminary report. J Urol 151:1193–1197

    Google Scholar 

  2. Abol-Enein H, Ghoneim MA (2001) Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral implantation: experience with 450 patients. J Urol 165:1427–1432

    CAS  PubMed  Google Scholar 

  3. Ahlering TE, Gholdoian G, Skarecky D, Weinberg AC, Wilson TG (2000) Simplified technique with short and long-term follow-up of conversion of an ileal conduit to an Indiana pouch. J Urol 163:1428–1431

    Google Scholar 

  4. Altwein JE, Jonas U, Hohenfellner R (1977) Long-term follow-up of children with colon conduit urinary diversion and ureterosigmoidostomy. J Urol 118:832–836

    CAS  PubMed  Google Scholar 

  5. Bricker EM (1950) Bladder substitution after pelvic evisceration. Surg Clin N Am 30:1511–1521

    CAS  PubMed  Google Scholar 

  6. Brown SCW, O’Reilly PH (1995) Glomerular filtration rate measurement: an neglected test in urological practice. Br J Urol 75:296–300

    CAS  PubMed  Google Scholar 

  7. Coffey RC (1911) Physiologic implantation of the severed ureter or common bile duct into the intestine. JAMA 56:397–403

    Google Scholar 

  8. Davidsson T, Åkerlund S, White T, Olaisson G, Månsson W (1996) Mucosal permeability of ileal and colonic reservoirs for urine. Br J Urol 78:64–68

    Article  CAS  PubMed  Google Scholar 

  9. Echtle D, Müller E, Kontaxis D, Wöhr M, Frohneberg D (2000) Why it works so well. Akt Urol 31:263–268

    Google Scholar 

  10. Elder DD, Moisey CU, Rees RW (1979) A long-term follow-up of the colonic conduit operation in children. Br J Urol 51:462–465

    CAS  PubMed  Google Scholar 

  11. Fontaine E, Leaver R, Woodhouse CRJ (2000) The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up. Br J Urol 86:195–198

    Article  CAS  Google Scholar 

  12. Ghoneim MA (2002) Editorial comment J Urol 168:1016–1017

    Google Scholar 

  13. Goodwin WE, Harris AP, Kaufman JJ, Beal JM (1953) Open transcolonic ureterointestinal anastomosis. A new approach. Surg Gynecol Obstet 97:295–300

    CAS  PubMed  Google Scholar 

  14. Gotoh M, Yoshikawa Y, Sahashi M, Ono Y, Ohshima S, Kinukawa T, Kondo A, Miyake K (1995) Urodynamic study of storage and evacuation of urine in patients with a urethral Kock pouch. J Urol 154:1850–1853

    Google Scholar 

  15. Granerus G, Aurell M (1981) Reference values for51Cr-EDTA clearance as a measure of glomerular filtration rate. Scand J Clin Lab Invest 41:611–616

    CAS  PubMed  Google Scholar 

  16. Hautmann RE (2003) Urinary diversion: ileal conduit to neobladder. J Urol 169:834–842

    Google Scholar 

  17. Hautmann RE, De Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T (1999) The ileal neobladder: complications and functional results in 363 patients after 11 years of follow-up. J Urol 161:422–427

    Article  CAS  PubMed  Google Scholar 

  18. Helal M, Pow-Sang J, Sandford E, Figuerson E, Lockhard J (1993) Direct (non-tunneled) ureterocolonic reimplantation in association with continent reservoirs. J Urol 150:835–837

    Google Scholar 

  19. Hodson CJ, Malling TMJ, McManamon PJ, Lewis MG (1975) The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis). Br J Radiol Suppl, 13:1-26

    Google Scholar 

  20. Hohenfellner R, Black P, Leissner J, Alhoff EP (2002) Refluxing ureterointestinal anastomosis for continent cutaneous urinary diversion. J Urol 168:1013–1017

    Google Scholar 

  21. Husmann DA, Mclorie GA, Churchill BM (1989) Nonrefluxing colonic conduits: a long-term life-table analysis. J Urol 142:1201–1203

    Google Scholar 

  22. Iborra I, Casanova JL, Solsona E, Ricos JV, Monros J, Rubio J, Dumont R (2001) Tolerance of external urinary diversion (Bricker) followed for more than 10 years. Eur Urol 39 [Suppl 5]:146

  23. Jonsson O, Olofsson G, Lindholm E, Törnqvist H (2001) Long-time experience with the Kock ileal reservoir for continent urinary diversion. Eur Urol 40:632–640

    Google Scholar 

  24. Kock NG, Nilson AE, Norlén L, Sundin T, Trasti H (1978) Changes in renal parenchyma and the upper urinary tracts following urinary diversion via a continent ileum reservoir . J Urol Nephrol [Suppl] 49:11–22

    Google Scholar 

  25. Kristjánsson A, Abol-Enein H, Alm P, Mokhtar AA, Ghoneim MA, Mansson W (1996) Long-term renal morphology and function following enterocystoplasty (refluxing or antireflux anastomosis): an experimental study. Br J Urol 78:840–846

    PubMed  Google Scholar 

  26. Kristjánsson A, Bajc M, Wallin L, Willner J, Mansson W (1995) Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 2. Renal scarring and location of bacteriuria. Br J Urol 76:546–550

    PubMed  Google Scholar 

  27. Kristjansson A, Engellau L, Willner J, Månsson W (1997) Reflux, stricture and glomerular filtration rate after two antireflux techniques in continent urinary reconstruction using the right colon. Scand J Urol Nephrol 31:425–429

    Google Scholar 

  28. Kristjansson A, Grubb A, Månsson W (1995) Renal tubular dysfunction after urinary diversion. Scand J Urol Nephrol 29:407–412

    Google Scholar 

  29. Kristjánsson A, Wallin L, Mansson W (1995) Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis ) or continent urinary diversion. 1. Glomerular filtration rate and patency of uretero-intestinal anastomosis. Br J Urol 76:539–545

    PubMed  Google Scholar 

  30. Lampel A, Fisch M, Stein R, Schultz-Lampel D, Hohenfellner M, Eggersmann C, Hohenfellner R, Thüroff JW (1996) Continent urinary diversion with the Mainz pouch. World J Urol 14:85–91

    CAS  PubMed  Google Scholar 

  31. Leadbetter WF, Clark BG (1954) Five years experience with ureteroenterostomy by the ‘combined’ technique. J Urol 73:67–82

    Google Scholar 

  32. Le Duc A, Camey M, Teillac P (1987) An original antireflux ureteroileal implantation technique: long-term follow-up. J Urol 137:1156–1158

    Google Scholar 

  33. Madersbacher S, Schmidt J, Eberle JM, Thoeny HC, Burkhard F, Hochreiter W, Studer UE (2003) Long-term outcome of ileal conduit diversion. J Urol 169:985–990

    Google Scholar 

  34. Månsson W, Davidsson T, Könyves J, Kiedberg F, Månsson Å, Wullt B (2003) Continent urinary tract reconstruction—the Lund experience. BJU Int 92:271–276

    Article  PubMed  Google Scholar 

  35. McDougal WS, Koch MO (1986) Accurate determination of renal function in patients with intestinal urinary diversions. J Urol 135:1175–1178

    Google Scholar 

  36. Nsihiyama T, Terunuma M, Takeda M, Katayama (2002) Renography as a measure of renal and neobladder function in patients with ileal bladder substitution. Urol Int 68:168–171

    Article  PubMed  Google Scholar 

  37. Pantuck AJ, Ken-Ryu H, Perrotti M, Weiss RE, Cummings KB (2000) Uretero-enteric anastomosis in continent urinary diversion: long-term results and complications of direct versus nonrefluxing techniques. J Urol 163:450–455

    Google Scholar 

  38. Pernet FP, Jonas U (1985) Ileal conduit urinary diversion: early and late results of 132 cases in a 25-year period. J Urol 3:140–144

    Google Scholar 

  39. Ransley PG, Ridson RA (1975) Renal papillary morphology and intrarenal reflux in the young pig. Urol Res 3:105–109

    Google Scholar 

  40. Rydström M, Tengström B, Cederquist I, Ahlmén J (1995) Measurement of glomerular filtration rate by single-injection, single-sample technique, using51Cr-EDTA or iohexol. Scand J Urol Nephrol 29:135–139

    Google Scholar 

  41. Sagalowsky AI (1998) Further experience with split-cuff nipple ureteral reimplantation in urinary diversion. J Urol 159:1843–1844

    Google Scholar 

  42. Schwaibold H, Friedrich MG, Fernandez S, Conrad S, Huland H (1998) Improvement of ureteroileal anastomosis in continent urinary diversion with modified Le Duc procedure. J Urol 160:718–720

    Google Scholar 

  43. Shaaban AA, Gaballah MA, El-Daisty TA, Ghoneim MA (1992) Urethral controlled bladder substitution: a comparison between the intussuscepted ileal nipple valve and the technique of Le Duc as antireflux procedures. J Urol 148:1156–1161

    Google Scholar 

  44. Singh G, Wilkinson JM, Thomas DG (1997) Supravesical diversion for incontinence: a long-term follow-up. Br J Urol 79:348–353

    Article  CAS  PubMed  Google Scholar 

  45. Starr A, Rose DH, Copper JF (1975) Antireflux ureteroileal anastomoses in humans. J Urol 113:170–174

    Google Scholar 

  46. St. Clair SR, Hixon CJ, Richey ML (1992) Enterocystoplasty and reflux nephropathy in the canine model. J Urol 148:728–732

    Google Scholar 

  47. Stein JP, Freeman JA, Esrig D, Elmajian DA, Tarter TH, Skinner EC, Boyd SD, Huffman JL, Lieskovsky G, Skinner DG (1996) Complications of the afferent antireflux valve mechanism in the Kock ileal reservoir. J Urol 155:1579–1584

    Google Scholar 

  48. Stein JP, Lieskovsky G, Ginsberg DA, Bochner BH, Skinner DG (1998) The T-pouch: an orthotopic ileal neobladder incorporating a serosal lined ileal anti-reflux technique. J Urol 159:1836–1842

    Google Scholar 

  49. Stein R, Fisch M, Beetz R, Matani Y, Doi Y, Hohenfellner K, Burger RA, Abol-Enein H, Hohenfellner R (1997) Urinary diversion in children and young adults using the Mainz Pouch I technique. Br J Urol 79:354–361

    Article  CAS  PubMed  Google Scholar 

  50. Steven K, Poulsen AL (2000) The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol 166:288–295

    Google Scholar 

  51. Studer UE, Ackerman D, Casanova GA, Zingg EJ (1988) A newer form of bladder substitute based on historical perspectives. Semin Urol 6:57–65

    CAS  PubMed  Google Scholar 

  52. Thoeny HC, Sonnenschein MJ, Madersbacher S, Vock P, Studer UE (2002) Is ileal orthotopic bladder substitution with an afferent tubular segment detrimental to the upper urinary tract in the long term? J Urol 168:2030–2034

    Google Scholar 

  53. Turner-Warwick RT (1960) Colonic urinary diversion. Proc R Soc Med 53:56–58

    Google Scholar 

  54. Turner-Warwick RT, Ashken MH (1967) The functional results of partial, subtotal and total cystoplasty with special reference to ureterocaecocysto-plasty, selective sphincterotomy and cystocystoplasty. Br J Urol 39:3–12

    PubMed  Google Scholar 

  55. Turner-Warwick R, Chapple C (2002) Functional reconstruction of the urinary tract and gynaeco-urology. Blackwell, Oxford

  56. Wood DPJr, Bianco FJJr, Pontes JE, Heath MA, DaJusta D (2003) Incidence and significance of positive urine cultures in patients with an orthotopic neobladder. J Urol 169:2196–2199

    Google Scholar 

  57. Wullt B, Holst E, Steven K, Carstensen J, Pedersen J, Gustafsson E, Collen S, Mansson W (2004) Microbial flora in ileal and colonic neobladders. Eur Urol 45:233–239

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Landspitali University Hospital, Reykjavik, Iceland

    Axel Kristjansson

  2. Department of Urology, Lund University Hospital, Lund, Sweden

    Wiking Mansson

Authors
  1. Axel Kristjansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wiking Mansson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kristjansson, A., Mansson, W. Renal function in the setting of urinary diversion. World J Urol 22, 172–177 (2004). https://doi.org/10.1007/s00345-004-0431-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-004-0431-y

Keywords

Search

Navigation