Objective:
Our study aimed to assess the incidence and risk factors for developing pyocystis in the remnant bladder following ileal conduit formation for benign aetiology, and to assess the management outcomes for these cases.

Methods:
A retrospective review was performed on all 106 patients (27 men) having ileal conduit urinary diversion for benign aetiology between 1998 and 2019. The mean age of patients was 52 years (range 20-83 years). Median follow up was 44 months (range 0 – 233 months). Notes were reviewed and data retrieved on patient demographics, aetiology, and the diagnosis, treatment and outcomes of pyocystis.

Results:
Table 1 below details the indications for ileal conduit formation, the cases which developed pyocystis in the remnant bladder and the latest management of this diagnosis.
40 patients (37.7%), 31 female and 9 male patients, developed pyocystis following ileal conduit formation. On average, the development of pyocystis occurred at 42 months (range 1 to 408 months) following ileal conduit formation. 37 patients (92.5%) presented with urethral discharge, 23 (57.5%) experienced pelvic pain associated with bladder spasms, 1 (2.5%) patient presented with haematuria. 12 patients (30%) developed acute infection or sepsis secondary to pyocystis.

Prior to ileal conduit formation surgery, 16 patients had a suprapubic catheter in situ, 7 had a history of intermittent self catheterisation, and 5 patients had a long term urethral catheter in place. However, these were not found to be statistically higher in the pyocystis group when compared to the non pyocystis group.
A history of bladder augmentation (clam cystoplasty and mitrofanoff channel) prior to ileal conduit formation is statistically significant risk factor for the development of pyocystis in the remnant bladder.
Treatment for pyocystis progressed through; conservative management with antibiotics, remnant bladder intermittent self catheterisation, remnant bladder washout, cystodiathermy and finally simple cystectomy. Table 2 below details the management of the pyocystis cases in this study.

The incidence of pyocystis development in the remnant bladder following ileal conduit formation is 37.7%. Long term or intermittent catheterisation of the bladder prior to urinary diversion surgery doesn’t appear to be risk factor for the development of pyocystis. However, previous bladder augmentation surgery is a statistically significant risk factor for the development of pyocystis. 60% of pyocystis cases are managed with a simple cystectomy. Patients who have ileal conduit formation surgery should be told of the risk of developing pyocystis and the risk of further surgery to manage this condition.