Long-term follow-up, further experience with and modifications of the transverse colon conduit in urinary tract diversion.
In the past 6 years, an additional 22 patients with extensive pelvic irradiation have had their upper urinary tracts diverted employing the transverse colon conduit. Most procedures were performed with radical cystectomy following high dose radiotherapy in patients with bladder cancer or with pelvic exenteration for recurrent cervical cancer. The operative mortality rate was unchanged at 4%. Upper urinary tracts and renal function have remained stable or improved in 88 and 95% of patients respectively. Although most conduits were constructed with refluxing ureterocolic anastomoses and without stents, the more recent procedures have employed both antireflux submucosal tunnel anastomoses and stents. Nineteen of 25 patients diverted by this method between 1970 and 1976 have been followed for up to 155 months. All patients with recurrent or persistent malignancy have died (mean survival 44 months). Seven patients (37%) are living and well (mean survival 104 months). Upper urinary tracts remain normal in two-thirds of those with the longer follow-up. Major complications requiring additional surgery continue to occur in one-third of this highly selected group of patients in whom the transverse colon conduit remains the preferred diversionary technique.