title: Reconstruction of urinary tract combined with surgical management of locally advanced non-urological cancer involving the genitourinary organs.
abstract: BACKGROUND
  The objective of this study was to review our experience with urinary reconstruction in patients undergoing surgical management for locally advanced pelvic cancer, and to evaluate the role of urologists in these procedures.
  
  
  METHODS
  This study included a total of 37 patients undergoing some type of urinary reconstruction due to invasion of the urological organs by locally advanced pelvic cancers, including 17 rectal cancers, 9 cervical cancers, 4 sigmoid cancers, 4 retroperitoneal sarcomas, 2 ovarian cancers and 1 appendiceal cancer. Among these 37, 18 were recurrent cancers following initial surgery for primary tumors. The clinical outcomes of these approaches were retrospectively analyzed.
  
  
  RESULTS
  Of the 37 patients, 9 underwent cystectomy (group A) with the following urinary diversions: ileal neobladder in 3, ileal conduit in 5 and colon conduit in 1, and 12 underwent partial cystectomy (group B), among whom 11 received additional urinary reconstruction as follows: bladder flap repair in 5, psoas hitch in 2, ileal ureter in 2, bladder augmentation in 1 and ureteroureterostomy in 1, while the remaining 16 (group C), in whom complete bladder preservation was possible, underwent the following types of urinary reconstruction: bladder flap repair in 6, psoas hitch in 3, en bloc removal of the rectum with prostate in 3, ileal ureter in 2, and ureteroureterostomy in 2. There were 10 early urological complications, including leakage of urine in 7 and acute pyelonephritis in 3. As a late urological complication, hydronephrosis was observed in 8 patients, but ureteral stent was not required in any of these 8. There were no significant differences in the incidence of postoperative complications, the status of surgical margin and the survival among groups A-C.
  
  
  CONCLUSIONS
  Our experience with extended surgical management of non-urological pelvic cancer with reconstruction of the urinary tract suggests that the urological portion of this procedure can be performed with acceptable morbidity, and that the role of the urological surgeon during this procedure is potentially important.
authors.affiliation: Department of Urology, Hyogo Medical Center for Adults, Akashi, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Harada
authors.forename: Iori
authors.initials: I
authors.lastname: Sakai
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Muramaki
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Kurahashi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Isao
authors.initials: I
authors.lastname: Hara
authors.forename: Taka-aki
authors.initials: TA
authors.lastname: Inoue
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000379:methods*