Abstract
Among 840 patients who received pelvic exenterations which entail total diversion of the urinary tract, a second or even third urinary tract rediversion was deemed necessary to preserve life-sustaining urinary tract function in 72. In those who lived more than five years after pelvic exenteration for advanced cancer, the most frequent cause of death was uremia or urinary tract sepsis. Once urinary diversion is done, constant surveillance is obligatory for evidence of progressing urinary tract deterioration. Rediversion is indicated under certain conditions as a life-saving measure in spite of its substantial risks. The variables in each case preclude the elaboration of hard and fast rules and the patient's management must be highly individualized. Among 58 patients in whom rediversion was done five or more years ago, 24 survived at least five years. Among 14 patients so operated upon within the past five years, three are living. All of the patients originally had advanced cancer.
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