Ileal Conduits – Adverse Reaction
Srinivas S, Mahalati K, Freiha FS [Veterans Affairs Med Ctr. Palo Alto, Calif; Stanford Med Ctr, Calif]
Methotrexate Tolerance in Patients With Ileal Conduits and Continent Diversions
Cancer 82: 1134-1136, 1998
Because the majority intravenously administered methotrexate is excreted in the urine, and because methotrexate is readily absorbed from the urinary tracts, there has long been a suspicion that the complications of methotrexate-based
chemotherapy were more severe among patients who have undergone radical cystectomy and urinary diversion. Moreover, there has been the implication that continent diversion and neobladder formation additionally highten the complications from methotrexate therapy.
These authors show that the type of urinary diversions , type of segment and the type of urinary drainage performed during chemotherapy had no impact on methotrexate based chemotherapy.
Previous studies suggesting a correlation of these factors with methotraxate toxicity were based on regimens using more than three times the dose of methotraxate used in contemporary chemotherapy regimens.
It is no longer reasonable to deny a patient with a relatively large and /or poorly differentiated, clinically localised bladder cancer the option of a continent diversion or neobladder.