Incontinent ileovesicostomy: Long-term outcomes and complications

Incontinent ileovesicostomy was popularized in the mid-1990s as a surgical option for patients with neurogenic voiding dysfunction who lack the dexterity to perform clean catheterization. There are several case series in the literature, but few studies look at the long-term outcomes and complications associated with this procedure.

We review the outcomes of 12 patients who underwent incontinent ileovesicostomy for management of neurogenic voiding dysfunction since its introduction at our institution in 1998. We discuss, specifically, the preoperative and postoperative problems encountered as well as complications pertaining to ileovesicostomy itself.

At an average of 5 1/2 years follow-up, all 12 patients who underwent incontinent ileovesicostomy have experienced some form of urinary tract problem either associated with the ileovesicostomy or with their underlying neurogenic voiding dysfunction. After ileovesicostomy, seven of 12 patients (58%) have been able to reduce antibiotic usage and/or hospital admission related to chronic upper tract infection. Two patients (17%) have subsequently been converted to ileal conduit.

Incontinent ileovesicostomy is a useful option for patients with lower urinary tract dysfunction who are unable to perform clean intermittent catheterization. It should be reserved for those patients who have exhausted less invasive therapy and in whom quality of life benefits cannot be achieved without diversion. Experience shows that there are no absolute indications for this procedure. The clinician and the patient must be aware of the importance of continued surveillance after this procedure for problems related to neurogenic voiding dysfunction and/or the ileovesicostomy itself.