THE CHANGES OF THE RENAL FUNCTION AFTER PERMANENT URINARY DIVERSION

Abstract

Permanent urinary diversion procedures were performed on 224 patients. The types of procedures performed were ileal conduit in 110 cases, ureterocutaneostomy in 72 cases and nephrostomy in 42 cases. These procedures were accomplished during the period from 1971 through 1981 at the Department of Urology, School of Medicine, Iwate Medical University and its affiliated hospitals. The renal functions were observed for postoperative changes.
The renal functions were observed through the use of pyelography, BUN, creatinine, serum electrolytes (Na, K, Cl, Ca), the PSP test, the Fishberg test and urinalysis. These observations were made preoperatively and on the 1st to the 7th postoperative day, the 8th to the 14th day, the 1st to the 3rd month, the 6th month, the 1st year and once every year thereafter.
The renal function was disturbed preoperatively in the renal fistula group, the uretero-cutaneostomy and ileal conduit groups in this order, and every subject of the nephrostomy group was afflicted with hydronephrosis.
A transient hydronephrosis was noted in the ileal conduit group in the first three month postoperatively, but returned to the normal after 6 months. The creatinine exhibited a change ranging from 1.0 to 1.2mg/dl.
The urinary tract remained without infection in 42.1% of the postoperative patients and in 60% of those whose urinary tract infection had disappeared within one year. The renal function was maintained favorably as a whole. Pyelography revealed an improvement by the 6th month in the ureterocutaneostomy group and in the nephrostomy group. The BUN and creatinine that had shown a decrease by the 6th month, were normalized. However, it re-elevated thereafter and the creatinine level remained at approximately 2.0mg/dl. Urinary tract infections were observed in 100% of the patients in both groups. In the absence of appropriate treatment, one can assume that renal function would tend to gradually decrease in both groups.