THE WALLACE TECHNIQUE OF URETEROILEAL ANASTOMOSIS AND ITS USE IN GYNECOLOGIC ONCOLOGY - A STUDY OF 81 CASES

Objective: To report the indications for surgery, morbidity, and resul ts of treatment using the Wallace ileal conduit for supravesical urina ry diversion. Methods: Over a 15-year period (1977-1991), 81 patients, all with an underlying gynecologic malignancy requiring urinary diver sion, had ileal conduit surgery performed at the Regional Department o f Gynecological Oncology, Gateshead, England using the Wallace techniq ue. Patient details stored in a computerized data base were reviewed r etrospectively. Results: Thirty-nine patients (48%) had received radio therapy before conduit surgery. In 70% of cases, urinary diversion was performed as part of an exenterative procedure. Early postoperative c omplications occurred in 56% of cases and were mainly related to infec tion. Long-term complications included fistula (three), stoma retracti on (three), loss of renal function (three), tumor metastases (two), an d stoma herniation (one). There was one postoperative death secondary to septicemia. By 1991, 42 patients (52%) had died of their primary di sease. Conclusion: We believe that for urinary diversion in the gyneco logic oncology patient, the ileal conduit, in particular the Wallace t echnique, is the procedure of choice.