Continent ileocolonic urinary reservoir (Miami pouch): the University of Miami experience over 15 years.
OBJECTIVE
A patient with a recurrent central pelvic malignancy after radiation will require urinary diversion as part of the reconstructive phase of the pelvic exenteration. The aim of our study was to assess the result of our 15-year experience with a continent ileocolonic urinary reservoir, which is known as the Miami pouch.


METHODS
Since 1988, all patients who received a continent ileocolonic urinary reservoir in the Division of Gynecologic Oncology, University of Miami School of Medicine, were included in the study. Parameters that were evaluated during the study period include functional outcomes, early and late perioperative complications, and their treatment.


RESULTS
A total of 90 patients were identified from February 1988 to December 2002. Seventy-eight patients (87%) had a recurrent central pelvic malignancy, and 82 patients (91%) received radiation before the Miami pouch procedure. The non-reservoir-related morbidities were fever (76%), wound complication (30%), pelvic collection (12%), ileus/small bowel obstruction (12%), and postoperative death (11%). The most common reservoir-related complications were urinary infection (40%), ureteral stricture (20%), and difficulty with self-catheterization (18%). In our study, the overall complication rate that was related directly to the Miami pouch was 53%. Conservative treatment resolved>80% of these cases. The rate of urinary continence that was achieved in our patients was 93% during our 15-year experience with the Miami pouch.


CONCLUSIONS
The Miami pouch is a good alternative for continent urinary diversion during exenteration or radiation-induced damage. The rate of major complications that require aggressive surgical intervention is acceptable. Most postoperative complications (80%) can be corrected with the use of conservative techniques that are associated with fewer deaths than reoperation and thus should be used first. The technique is simple and effective in women who are at high risk, who have undergone previous radiation therapy, and who have a high rate of functional success and is a profound advantage for a woman's psychosocial well-being.
Salom
Emery M
EM
University of Miami, School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, Division of Gynecologic Oncology, 33136, USA. esalom@med.miami.edu
Mendez
Luis E
LE
Schey
Dana
D
Lambrou
Nicholas
N
Kassira
Noor
N
Gómez-Marn
Orlando
O
Averette
Hervy
H
Peñalver
Manuel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery; D005260:Female; D005431:Florida / Q000453:epidemiology; D005833:Genital Neoplasms, Female / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000601:surgery; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D014549:Urinary Incontinence; D016476:Urinary Reservoirs, Continent / Q000706:statistics & numerical data