After urinary diversion with ileal conduit for benign indications, most patients are left with a defunctionalised remnant bladder. It is recognised that pyocystis is a common complication in this setting but can be difficult to treat. In our patient cohort undergoing ileal conduit diversion for benign aetiology we sought to assess the incidence and risk factors for pyocystis and evaluated the management of pyocystis at our institution and requirement for subsequent remnant bladder cystectomy.

A retrospective review was performed of all patients at our institution undergoing urinary diversion with ileal conduit (benign causes) over a 9 year period (1997-2004). Data sets collected included demographics, co-morbidities, indication for diversion, incidence of post-operative pyocystis and management of pyocystis and requirement for subsequent remnant bladder cystectomy. Statistical analysis was performed to assess if any patient factors were associated with the development of pyocystis or requirement for subsequent cystectomy.

81 patients were identified over the 9 year period studied with a mean age of 46 years (range 2-78years) and mean follow-up of 49months (range 6-252months). 66 patients were female (81%) and 15 (19%) male. The indications for ileal conduit diversion included: end-stage complex urinary incontinence, atonic bladder, bladder pain syndrome and fowler’s syndrome. 

24% of the cohort developed pyocystis (n=19). Treatments utilised for pyocystis included: antibiotics, intermittent catheterisation +/- washout of remnant bladder and remnant bladder cystectomy.
Table 1 summarises the association of pyocystis with relevant patient factors identified in our analysis. 

No patient factors were found to have a statistically significant associated with pyocystis development but both male gender and pre-diversion suprapubic catheterisation show a trend towards being associated with pyocystis. 
95% of patients with pyocystis required eventual remnant bladder cystectomy and the association is statistically significant (p<0.01). Indeed the only patient with pyocystis not undergoing cystectomy was due to lack of medical fitness for further general anaesthetic.

There were no patient factors identified as having a statistically significant association with pyocystis development but both male gender and pre-diversion suprapubic catheterisation show a trend towards being associated with pyocystis. 
95% of patients with pyocystis required eventual remnant bladder cystectomy and the association is statistically significant (p<0.01). Indeed the only patient with pyocystis not undergoing cystectomy was due to lack of medical fitness for further general anaesthetic.

In our cohort pyocystis occurs in 24% of patients after ileal conduit urinary diversion for benign aetiology. Pyocystis is difficult to treat and does not respond to conservative treatments and requires remnant bladder cystectomy in 95% of cases. 
No statistical significant associations were found between patient factors and development of pyocystis. However, we note a trend in our data for male gender and pre-diversion suprapubic catheterisation and the development of pyocystis. As our cohort matures and expands, we postulate that increased patient numbers may show this to achieve statistical significance.