Urinary diversion in therapy of pelvic cancer; an appraisal of ileal-ureteral anastomosis.

In 43 cases, diversion of the urinary stream was carried out by means of an end-to-side anastomosis of ureters into an ileal segment. Forty-one of these operative procedures were performed in conjunction with the primary or secondary surgical treatment of malignant neoplasm arising in the pelvis. There were six postoperative deaths in this group of patients, none due to the urinary diversion. The remaining patients were observed for periods of from three to sixty months, the mean average eighteen months. During that period, only one patient died (at 42 months) as the result of urinary diversion. In that case death came about because the patient insisted on wearing a Foley retention catheter rather than an ileostomy bag, and the catheter perforated the ileal segment. In only three of the patients did pyelonephritis develop, and the disease was controlled by giving chemotherapeutic agents. In ten patients, some changes in postoperative intravenous pyelograms were observed.