HIGH-DOSE PELVIC IRRADIATION FOLLOWED BY ILEAL NEOBLADDER URINARY-DIVERSION - COMPLICATIONS AND LONG-TERM RESULTS

Objective To determine the risk of post-operative complications in pat ients receiving high-dose pelvic irradiation before radical cystectomy and urinary diversion. Patients and methods Of 300 patients who under went orthotopic bladder replacement at our institution from 1986 to 19 94. 11 patients (mean age 53 years, range 53-74) did so after receivin g high-dose pelvic irradiation. The indication for cystectomy and urin ary reconstruction was bladder cancer in seven men, prostate cancer in two men and a contracted bladder due to combined external pelvic irra diation and afterloading radiotherapy in two women. Results The post-o perative course, including the duration of hospital stay, peri-operati ve complications and early functional results, did not differ from a c ontrol group of non-irradiated patients, and no patients died, The mea n follow-up was 22 months (range 10-37) and revealed satisfactory resu lts in seven of 11 patients. A neovesicoperitoneal fistula developed i n one woman 10 months after surgery and was repaired by laparotomy. A neovesicovaginal fistula led to supravesical urinary diversion in the second woman. Conclusions High-dose pelvic irradiation should not be a primary contra-indication for orthotopic urinary diversion using segm ents of small intestine. For patients who undergo combined external an d afterloading radiotherapy, the indication for orthotopic bladder rep lacement should be considered critically.