Evaluation and Management of the Failed Ileovesicostomy

During an ileovesicostomy, urine is diverted to an abdominal stoma at low pressures, thereby avoiding the morbidity associated with cystectomy and allowing for the maintenance of native vesicoureteral junctions. This procedure gained popularity in the 1990s as an option for patients who were physically unable or unwilling to perform clean intermittent catheterization. Initial case series revealed fairly low morbidity with ileovesicostomy. However, subsequent larger case series revealed long-term complications that compromised the efficacy of ileovesicostomy, including recurrent urinary tract infections, bladder stones, upper urinary tract stones, urethral incontinence (persistent or de novo), fascial/stomal stenosis and ileal limb obstruction. Herein, we discuss the presentation, evaluation, and management of failed ileovesicostomy. In patients with an ileovesicostomy, recurrent urinary tract infections, urolithiasis, urinary incontinence and ileal limb obstruction should be evaluated with physical examination, fluoroscopic urodynamics and cystoscopy to determine the need for ileovesicostomy surgical revision, closure of the bladder outlet, repair of fistula or cystectomy with ileal conduit.