Introduction: Use of colon for urinary conduit diversion is often performed when there is a lack of viable ileum due to inflammatory small bowel disease, prior small bowel resection, or radiation related changes as a result of prior pelvic radiation. While short and long-term outcomes have been well studied in the ileal conduit population, there is a paucity of evidence assessing complications following colon conduit urinary diversion. Thus, we sought to elucidate the incidence and impact of high-grade complications (Clavien-Dindo IIIa-V) following colon conduit urinary diversion.
Methods: We performed a single institution, retrospective cohort study of patients undergoing colon conduit urinary diversion between April 2011 – January 2021. Perioperative characteristics were assessed including prior radiation, albumin, prealbumin, creatinine, and eGFR. Post-operative 30 and 90-day outcomes were characterized including length of stay, high-grade complication rates, readmission rates, and 90-day procedural/surgery rate.
Results: We identified 36 patients, median age 60 years [IQR 52,70] who underwent colon conduit urinary diversion during our study period. Colon segments utilized included transverse colon (63.8%), colon switch (19.4%), and sigmoid colon (16.7%). Active tobacco use at the time of surgery occurred in 14.8% of patients. Prior radiotherapy was common with 76.5% and 22.2% reporting prior history of external beam radiation and brachytherapy, respectively. Preoperative characteristics, median [IQR], included: body mass index 26.5 [22.9, 30.8], albumin 3.70 [3.2, 3.9], prealbumin 21.8 [17.6, 32.9], creatinine 0.9 [0.73, 1.20], and eGFR 83 [53, 101]. Median length of stay was 11 days [8, 15]. 30 and 90-day high grade complications were common, occurring in 33.3% and 52.7% of patients, respectively. Within 30-days of surgery, 27.8% of patients required readmission, which increased to 61.1% by 90 days after surgery. More than 1 readmission within 90 days of surgery occurred in 19.5%, while the incidence of a secondary procedure/surgery occurring over the same time period was 33.3%.
Conclusions: In a cohort with a high prevalence of prior pelvic radiation therapy, the risk of high-grade complication, readmission within 90 days of surgery, and secondary procedure/surgery following colon conduit urinary diversion was high. The addition of multi-institutional data is necessary to better characterize the post-operative risks associated with colon conduit diversion in this patient population.
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