INCIDENCE AND MANAGEMENT OF MAJOR URINARY COMPLICATIONS AFTER PELVIC EXENTERATION FOR GYNECOLOGICAL MALIGNANCIES

Urinary fistulae and obstruction following pelvic exenteration are fre quent and life-threatening complications. They increase the mortality and morbidity rates of large exereses performed during pelvic exentera tion for gynecological cancers. From a series of 97 patients who under went pelvic exenteration for gynecological cancers we report the incid ence, risk factors, and management of major urinary complications. Eig hty patients had had previous surgery and/or pelvic radiation therapy at the time of pelvic exenteration. A urinary diversion was performed in 63 patients. Major early urinary complication were: urinary fistula in seven patients and ureteral obstruction in four patients (11.3% of the patients). Ten patients had a late urinary complication: stenosis of the cutaneous ureteral meatus (five), stenosis of the ureteroileal anastomosis following ileal loop (two), and urinary fistulae (three). Cancer recurrence was found in 4 of these 10 cases. Major early urina ry complications were significantly increased in patients who had rece ived previous pelvic radiation therapy (P < 0.05) and in patients who had had an intestinal conduit for urinary diversion (P < 0.05). Reoper ation was done in six of seven cases of early urinary fistula (urinary undiversion four, nephrectomy one, ureteral reimplantation one). Thre e of four ureteral obstructions were managed with percutaneous nephros tomy and ureteral stent. We recommend the use of nonirradiated bowel s egment for urinary diversion as transverse colon or jejunal conduit in patients who have received previous high doses of pelvic radiotherapy . For the management of urinary complications post pelvic exenteration , reoperation is required for most urinary fistula but ureteral obstru ctions can be managed with percutaneous nephrostomy and ureteral stent . (C) 1995 Wiley-Liss, Inc.