Substitution of the bladder with segment of the digestive tract, within the
radical treatment of bladder cancer, as well as treatment of the other
bladder abnormality, is extremely demanding surgical procedure, that aims
adequate treatment of the underlying disease and provide patient?s renal
function within physiological level. Surgical implantation of the ureter
into the intestinal segment are an important part of the surgical technique,
the formation of ileal conduit, with the ultimate aim of providing a more
natural way of evacuation of urine from the upper urinary tract in terms of
maintaining the adequate quality of renal function. Which of the existing
surgical method of implantation of ureter in the intestinal segment will be
applied, it is for urologist to decided, according to his affinity and/or his
operating school of origin. The literature describes many procedures of this
technique (Wallace A, B Wallace, Nesbit-Bricker, Le Duc). Bearing in mind
that the ileal conduit, as a form of supravesical derivation, is still one of
most widely used method of urinary diversion, with a very large number of
patients during the follow-up period were recorded certain complications of
renal function disorders, which by some authors attributed to a type of
ureterointestinal anastomoses, during the creation of ileal conduit.
Having in mind the fact of unnatural route of elimination of urine from the
upper urinary tract that occurs during creation of ileal conduit, it is
reasonable to expect some degree of renal deterioration. These
complications require prompt resolution. Bearing in mind the fact of
unnatural route of elimination of urine from the upper urinary tract that
occurs during creation of ileal conduit, it is reasonable to expect that the
renal function over the time will start to show signs of incipient or
advanced failure7. Objective: The main objective is to show the degree of
renal deterioration, postoperatively, according to the type of insertion of
the ureters to the ileal conduit. Methods and patients: The study was
conducted retrospectively on material of Urological Clinic, Clinical Center
of Serbia and on material of Faculty of Medicine, University of Belgrade, on
193 patients, for a period of five years (2007 to 2011), with a time of
postoperative follow-up of patients up to 48 months (four years). Assessment
of the level of renal deteriorisation was performed by ultrasound examination
during regular audits of patients during follow-up. Conclusion: It was found
that all three examed techniques in an insertion of ureter into ileal conduit
were equally satisfactorily, with the similar degree of postoperative
complications. Based on these facts, we can conclude, that the quality of
life of patients in all three analyzed groups of ureteral insertion in the
ileal conduit, approximately the same.
Renal function of bladder cancer patients after urinary diversion by ileal conduit in Rajavithi Hospital