The Role of the Ileal Conduit in the Development of Upper Tract Dilatation

Abstract

The purpose of this study was to clarify the role of the conduit in the development of upper tract dilatation after ileal conduit urinary diversion. Twenty-seven patients with a normal upper tract were compared with 17 who had developed upper tract dilatation. Patients were studied by means of a technique to measure pressure and flow under "steady-state" conditions. Pressure activity was classified into two types. Type I pressure activity (frequency 6.2 +/- 3/min; amplitude 4.7 +/- 3 cm H2O) resulted in to-and-fro movement of contrast and the escape into the appliance of small volumes of contrast. In controls, most of the output from the conduit occurred during type I activity (73 +/- 14%). Type III/IV pressure activity resulted in vigorous aboral peristalsis and occurred infrequently in controls (frequency 5 +/- 4/h). In patients with upper tract dilatation, in contrast, type III/IV peristaltic activity occurred frequently (frequency 37 +/- 30/h; P less than 0.001: amplitude 72 +/- 34 cm H2O) and was responsible for most of the output (70 +/- 17%; P less than 0.001). The findings support the hypothesis that high pressure activity in the conduit is an important factor in the aetiology of upper tract dilatation, and they are compatible with the presence in such patients of functionally important obstructions of the distal conduit.

Long-Term Followup of Augmentation Enterocystoplasty and Continent Diversion in Patients With Benign Disease

“…What is clear is the significant incidence of renal deterioration with time in patients who have received a classic Bricker ileal conduit, which is presumed to be related to a combination of ureteral ischemia and high pressure in the intact ileal segment. [12][13][14] The usual indications for creating an abdominal stoma include women with spasticity of the lower extremities who are wheelchair bound because of neurological conditions, patients of each sex with urethral obstruction and those with refractory sphincteric incontinence or fistulas.…”

Revisiting the use of ileal conduit urodynamics

“…at 2 cm and 10 cm over time. 1 In the case presented, the urodynamics trace demonstrated some high-pressure Type III waves with no antegrade wave transmission. This was concluded to be equivocal but on balance, in keeping with obstruction.…”

“…She underwent conduit urodynamics described by Neal et al 1 After antibiotic prophylaxis, a 12Fr triple lumen catheter was passed into the ileal conduit under radiological screening on an x-ray table. Pressure was measured 2 cm and 10 cm just distal to the uretero-ileal anastomosis (UIA).…”

“…We carried out repeat investigations including a computed tomography (CT) abdomen and pelvis with contrast, a conduit loopogram and mercapto-acetyltriglycine (MAG3) renogram, but no radiological evidence for conduit obstruction or stricture was seen. She underwent conduit urodynamics described by Neal et al 1 After antibiotic prophylaxis, a 12Fr triple lumen catheter was passed into the ileal conduit under radiological screening on an x-ray table. Pressure was measured 2 cm and 10 cm just distal to the uretero-ileal anastomosis (UIA).…”

“…Filling was slow fill and then physiological as described. 1 The trace was analysed according to the type of pressure wave conducted between the 10 cm and 2 cm recording. The patient fell into the equivocal group with no clear transmission of the pressure wave, but with no significant rise in pressure suggesting obstruction (Figure 1).…”