Continent ileocolonic urinary diversion (Rome pouch) for gynecologic malignancies: technique and feasibility.
OBJECTIVE
To describe the technique, feasibility and early complications of "Rome pouch" urinary diversion.


METHODS
Thirty-five consecutive patients affected by advanced or recurrent gynecological cancers who required anterior or total pelvectomy entered the study. Rome pouch technique starts with the transection of terminal ileum about 12 cm from the ileocecal valve; the large colon is transected 15-20 cm distal to the hepatic flexure. The intestinal wall tension and internal pressure are reduced using 5-8 transverse teniamyotomies of the cecum. The efferent segment of the pouch is created either with the appendix or with the distal ileum. Operative data, intra- and early postoperative complications were recorded.


RESULTS
Between February 2000 and March 2006, an ileocolonic urinary diversion (Rome pouch) was carried out in 35 patients affected by advanced or recurrent gynecologic malignancies. The average operative time to complete the anterior and total exenteration including reconstruction procedure was 285 (range, 230-350) and 320 (range 280-415) min, respectively. The average time in performing the Rome pouch technique was 60 min (range, 45-90). Overall postoperative complication rate (major and minor complications) was 82% (29 patients). Febrile morbidity occurred in 26 patients (74%). Wound complications and pelvic collection were found in 7 (20%) and 6 (17%) patients, respectively.


CONCLUSIONS
Our experience demonstrated that Rome pouch technique represents a valid alternative in gynecology oncology for continent urinary diversion. This technique showed low rate of medical and early urologic complications. The simplicity of performing the procedure and the reduced operating time are the best goals reached by Rome pouch technique. Future comparative trials will better define the role that the Rome pouch will have in these patients.
Panici
Pierluigi Benedetti
PB
Department of Obstetrics and Gynecology, La Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Angioli
Roberto
R
Plotti
Francesco
F
Muzii
Ludovico
L
Zullo
Marzio Angelo
MA
Manci
Natalina
N
Palaia
Innocenza
I
Galluci
Michele
M
D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008875:Middle Aged; D010385:Pelvic Exenteration; D016896:Treatment Outcome; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D014846:Vulvar Neoplasms / Q000601:surgery