Urologic function and urodynamic evaluation of urinary diversion (Rome pouch) over time in gynecologic cancers patients.
OBJECTIVE
To describe the urologic late complications and urodynamics outcome adopting teniamyotomies technique to create a low-pressure reservoir using the cecum, ascending colon and proximal part of the transverse colon without detubularization (Rome pouch).


METHODS
Twenty-eight consecutive patients affected by gynecological cancer and submitted urinary diversion with "Rome pouch" technique were included. After 3 and 12 months from the surgical procedure patients were submitted to urodynamic evaluation of the neobladders. Excretory urography was performed in all patient. Abdominal X-ray, serum electrolytes, creatinine and cultures of the reservoir are obtained during every visit. Long-term urologic complications were recorded. Patient quality of life was assessed using a 10 cm grade visual analog scale (VAS).


RESULTS
Urodynamics performed 12 months postoperatively showed that the mean maximum reservoir capacity was 439.9+/-58.9 cm H(2)O. The mean reservoir pressure at maximum capacity was 19.2+/-8.4 cm H(2)O (no contractive wave during the filling in any patient). The mean maximum closure pressure in the efferent tube, at maximum capacity, was 88.8+/-32.3 cm H(2)O. Continence was excellent for 26 (93%) and 23 (92%) patients at 3 and 12 months respectively. A total of 9 (32%) and 6 (24%) patients suffered late complications at 3 and 12 months follow-up respectively. However only one patient with pouch leakage underwent surgical pouch revision.


CONCLUSIONS
Our experience demonstrated that Rome pouch creation with multiple teniamyotomies has good capacity with low internal pressure and good continence with a low rate of late urologic complications. Thus, comparing results to those of other continent pouch models, the Rome pouch technique represents a valid alternative.
Angioli
Roberto
R
Department of Obstetrics and Gynecology, Campus Bio Medico, University of Rome, Rome, Italy.
Zullo
Marzio Angelo
MA
Plotti
Francesco
F
Bellati
Filippo
F
Basile
Stefano
S
Damiani
Patrizio
P
Perniola
Giorgia
G
Calcagno
Marco
M
Panici
Pierluigi Benedetti
PB
D000328:Adult; D000368:Aged; D002432:Cecum / Q000601:surgery*; D003106:Colon / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D004573:Electrolytes / Q000097:blood; D016889:Endometrial Neoplasms / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010385:Pelvic Exenteration; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D014563:Urodynamics; D014567:Urography; D002583:Uterine Cervical Neoplasms / Q000503:physiopathology / Q000601:surgery; D014846:Vulvar Neoplasms / Q000503:physiopathology / Q000601:surgery
D004573:Electrolytes; D003404:Creatinine