Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 1. Glomerular filtration rate and patency of uretero-intestinal anastomosis

Abstract

Objective: To evaluate the glomerular filtration rate (GFR) and incidence of anastomotic stenosis in patients with urinary diversion by ileal or colonic conduit (refluxing or anti-reflux uretero-intestinal anastomosis) or with a continent caecal reservoir.

Patients and methods: All conduit urinary diversions performed from 1977 to 1984 were randomized by type (ileal or colonic) and by the method of ureteric implantation (with or without anti-reflux technique). In continent caecal reservoirs anti-reflux implantation was used for both ureters. Total and separate GFR were measured pre-operatively and after a mean follow-up of 123 months (range 36-198) with 51Cr-EDTA and scintillation renography.

Results: Of the 56 evaluable patients, 18 had an ileal and 20 a colonic conduit, and 18 had a continent reservoir. The total mean GFR fell from 88 to 71 mL/min in the ileal group, from 84 to 65 mL/min in the colonic group and from 100 to 85 mL/min in the reservoir group. Separate GFR did not differ significantly between kidneys with and without reflux protection in the patients with a conduit diversion. Strictures occurred in 15 uretero-intestinal anastomoses and were unrelated to the mode of ureteric implantation (in the conduit groups). Renal function improved after ureteric reimplantation in six of seven kidneys, but after balloon dilatation in only one of five.

Conclusion: GFR fell moderately in all three groups, with no significant intergroup difference, and the continent caecal reservoir compared favourably with conduit diversion. The fall in separate GFR did not differ significantly between kidneys with and without reflux protection. Surgical exploration of uretero-intestinal stenosis is recommended if renal function is threatened.