Functional outcomes and complications of continent urinary diversions in patients with gynecologic malignancies.
OBJECTIVE
The purpose of this study was to review our experience with continent urinary diversions in patients with gynecologic malignancies and evaluate the presentation and management of early and late complications.


METHODS
A retrospective chart review was performed of all patients who underwent a continent urinary diversion on the Gynecologic Oncology Service at The University of Texas M. D. Anderson Cancer Center during the period January 1988 to March 2001. We analyzed our data to evaluate potential risk factors for complications. Renal status, conduit integrity, and overall patient outcomes were also studied.


RESULTS
We identified 40 patients who underwent a continent urinary diversion using an ileocolonic segment (Miami pouch technique). All patients had a history of gynecologic malignancies. The median age at the time of the procedure was 50 years (range 24 to 76 years), and the median weight was 69.6 kg (range 47 to 125 kg). A total of 39 patients (98%) had a history of radiotherapy. Continent urinary diversion was performed as part of an anterior pelvic exenteration in 12 patients (30%), in conjunction with a total pelvic exenteration in 18 patients (45%), and as the main procedure in 10 patients (25%). The median estimated blood loss was 2100 ml (range 200 to 8500 ml). The median length of hospitalization was 19.5 days (range 7 to 56 days). A total of 24 patients (60.0%) had a postoperative complications unrelated to the reservoir. Complications directly related to the continent urinary diversion were seen in 26 (65.0%) of 40 patients. None of the patients in this study group developed chronic renal failure, and there were no perioperative deaths. At last evaluation, 36 (90%) of 40 patients reported normal continent conduit function.


CONCLUSIONS
Continent urinary diversion using an ileocolonic segment is a reasonable alternative to the ileal and transverse colon conduit in bladder reconstruction in patients undergoing radical pelvic surgery. The routine use of postoperative total parenteral nutrition, the chronic use of antibiotics after discharge from the hospital, and the routine use of imaging studies remain controversial. In this group of patients, the majority of complications may be successfully managed conservatively.
Ramirez
Pedro T
PT
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. peramire@mdanderson.org
Modesitt
Susan C
SC
Morris
Mitchell
M
Edwards
Creighton L
CL
Bevers
Michael W
MW
Wharton
J Taylor
JT
Wolf
Judith K
JK
D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods*