Long-term follow-up of continent urinary diversion after pelvic exenteration for gynecologic malignancies

Abstract

Objective. The objective of this retrospective study was to analyze the long-term outcome of patients undergoing a continent urinary diversion (UD) at the time of pelvic exenteration (PE). Patients and methods. Between February 1993 and January 2001, 60 PE for gynecologic malignancies and requiring a UD were performed. Patient's preference, type of UD planned, type of UD performed, and late urinary morbidity (after day 90) were analyzed. Results. Eighty-two percent of the entire group (49/60) matched preoperatively criteria to have a continent UD and 41 continent UD were eventually performed (87%). Postoperative mortality in patients with a continent UD was 4.9% (2/41) and wasn't related to urinary complications. After a 20-month median follow-up, 18 patients (46%) with a continent UD developed late complications directly UD-related. These complications were: (a) major in 28% (5/18) requiring re-operation in 3 cases or endoscopic treatment in 2 cases; (b) minor in 72% (13/18) constantly medically treated. Chronic diarrhea was more frequent in patient who had small bowel or left colon resection ( P < 0.05) and urine leakage was more frequent in patient with higher BMI ( P < 0.05). At last follow-up, no patient had stopped self-catheterizations or asked for undiversion. Conclusions. In our experience, continent UD at the time of PE despite high acceptability and feasibility rate, appeared to be strongly related to specific late complications, uncommon with ileal conduit. However, these complications remained more frequently minor and could be treated safely and conservatively.