USE OF ILEOCECAL CONTINENT URINARY RESERVOIR IN PATIENTS WITH PREVIOUS PELVIC IRRADIATION

Objective. To assess the results of the use of ileocecal continent uri nary reservoirs in patients with previous pelvic irradiation, Methods, A retrospective analysis for morbidity and clinical outcome was under taken for 37 female patients with prior therapeutic pelvic irradiation who underwent continent urinary diversion with a detubularized right colonic segment as the urinary reservoir, a plicated ileocecal valve a s the continence mechanism, and a tapered distal ileum for efferent ca theterization. Results, Thirty-one patients had persistent or recurren t pelvic malignancies, 17 of whom had total pelvic exenteration and 14 had anterior exenteration, The remaining 6 patients had radiation-ind uced vesicovaginal fistulas without evidence of recurrence and underwe nt urinary diversion alone. Follow-up ranged from 2 to 33 months (medi an 11 months), Postoperative radiographic evaluation revealed no evide nce of urinary extravasation, Of the 74 implanted ureters, 4 had reflu x (5%), 2 developed stricture (3%), and 5 had mild to moderate hydrone phrosis (7%), All patients achieved daytime continence with catheteriz ation intervals of 3-8 hr (median 4 hr) and capacities of 200-1000 cc (median 500 cc), Nighttime continence was reported by 33 of 37 patient s (89%), Reoperation was required in 3 patients (8%), 2 with stoma ste nosis and 1 with difficulty in catheterization. Conclusions, The use o f the ileocecal continent urinary reservoir in patients with previous pelvic irradiation achieves results comparable to those reported for n onirradiated patients, thus supporting its use in this select group of patients. (C) 1995 Academic Press, Inc.