Long-term management of patients who have had urinary diversions into colon.

Thirty-four patients with urinary-colonic diversions have been followed up for 13 to 41 years (mean 20.3). The commonest long-term complication was hyperchloraemic acidosis (50%). The most serious was neoplasm at the anastomotic site: benign lesions occurred in three patients and carcinomas in two (15%). Staining for sialomucins in colonic biopsies adjacent to the anastomoses was positive in 17 of 19 patients. It has been suggested that this represents a pre-malignant change. Analysis of faecal flora in 17 diverted patients and 27 controls revealed a significant difference in the carriage rate and viable count of Peptostreptococcus species. This finding has not been reported previously and the species could have a role in the aetiology of the neoplasms.