Although urinary diversion procedures are commonly performed, they carry the risk of significant complications.
Three experts will discuss the management of some common and uncommon complications of urinary diversions during Tuesday morning’s Next Frontier plenary session in Ballroom East of the Boston Convention and Exhibition Center. Margit Fisch, MD, PhD, will moderate the 20-minute Complex Cases session, which begins at 8:30 a.m. and is titled Complications of Urinary Diversions.
Clinicians should “consider the possibility of a complication when performing the initial diversion,” said Dr. Fisch, Head of the Department of Urology at University Medical Center Hamburg-Eppendorf in Germany. “Clinicians should consider which technique has fewer complications and what they can do to avoid complications.”
The presentation will begin with a case involving the use of ileal conduit. This technique “is still the diversion most commonly used worldwide and it has a significant complication rate in the long run,” Dr. Fisch said. Those complications can include stoma stenosis, parastomal herniation, a “syphon”-like loop with recurrent urinary tract infections and ureteral stenosis at implantation. The expert panel will discuss the work-up and management of the patient in the case study and discuss how to avoid additional adverse events.
Another case involves stenosis at the ureteral implantation site, which can occur no matter which diversion technique is used.
“It’s a severe complication, and in almost all cases a surgical revision is required, which is not easy in a patient who already had a previous transabdominal intervention,” Dr. Fisch said. The panel will review techniques available for reimplantation and discuss in which cases an anti-refluxive ureteral implantation may be required.
The group will also discuss complications following urinary diversions with continent stoma. They will review the treatment of patients when this mechanism fails, including operative options and techniques.
In some cases, a complication arises that is so severe that the initial diversion must be abandoned and another form of diversion used in its place. This is known as conversion.
“This is a major surgery,” Dr. Fisch said. “It’s always an individual decision and there are no clear rules, only principle. Revisional surgery is complex and should be performed by surgeons who are able to use the whole armamentarium of techniques.”
Dr. Fisch will be joined on the panel by Jeremy B. Myers, MD, associate professor at the University of Utah and Co-director of the University of Utah’s Center for Reconstructive Urology and Men’s Health; Andrew C. Peterson, MD, professor of Urologic Surgery at Duke University Medical Center; and Suzanne B. Merrill, MD, assistant professor of Surgery and a Urologic Oncologist at the Penn State Milton S. Hershey Medical Center.