Passive ileal segment urinary diversion in advanced cervical carcinoma--a retrospective review.
OBJECTIVE
Urinary diversion is a clinical management option that gynaecological oncologists often use for urinary fistulas associated with cervical cancer. We retrospectively reviewed the indications and postoperative morbidity and mortality associated with this procedure.


METHODS
The case records of all patients with cervical carcinoma undergoing a passive ileal segment urinary diversion at King Edward VIII Hospital in Durban between 1 January 1991 and 31 December 1995 were reviewed retrospectively. The patient profile, indication for the operation and postoperative morbidity and mortality were noted.


RESULTS
Sixty-five patients were entered into the study. Thirty-two patients (49%) had untreated advanced cervical carcinoma, 12 (19%) had had prior palliative irradiation for cervical carcinoma and 21 (32%) had received prior radical radiotherapy for cervical carcinoma. Fifty per cent of patients experienced significant postoperative morbidity. This was especially high in those patients who had received prior radical radiotherapy (67%). Twelve patients (19%) died before discharge. Six (50%) of those who had received prior radical radiotherapy died following the procedure. Advanced age (more than 65 years), previous radical radiotherapy, extrapelvic metastatic carcinoma and re-laparotomy for complications of the procedure were significant risk factors for postoperative mortality in our study.


CONCLUSIONS
Careful patient selection, the use of bowel free of radiation injury, supportive management of postoperative complications and the establishment of a specific unit of trained staff are essential in order to ensure a successful outcome in patients undergoing this procedure.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013536:Suture Techniques; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000601:surgery*