[Ileal conduit and urinary stoma complications]

The ileal conduit has been widely used for urinary diversion. It is a safe procedure with acceptable results, but it has become clear that the conduit can give rise to serious complications, notably renal deterioration in the long run. Stenosis of the ileal conduit, usually developing insidiously many years after the diversion, may be the cause of upper urinary tract damage. In most cases, a variety of possible factors is considered, including microvascular ischemia, urine-borne toxic material, infectious and allergic stimuli and an immunologic defect. Crohn's disease may affect an ileal loop urinary conduit. It presents as a diffuse loop stenosis. Recurrent transitional carcinoma arising within an ileal conduit following cystectomy for malignant disease is rare, but late malignancy in bowel segments exposed to urine without fecal stream is well known. In literature, distinction between conduit complications of patients with underlying benign disease and those with malignancy has not always been clear. Stoma and skin complications are frequently observed and the patients who practiced inadequate stoma care routines are more likely to show peristomal skin complications. Patients bearing an abdominal urostomy should be followed up stringently in stoma centers.