URINARY COMPLICATIONS OF MIAMI POUCH - TREND OF CONSERVATIVE MANAGEMENT

OBJECTIVE: Continent urinary diversions have become popular among gyne cologic oncologists. Much information has been gained concerning the c omplications and current management of patients with continent ileocol onic reservoirs. The high mortality rate associated with reoperation h as led clinicians to adopt a trend toward conservative means of manage ment. The purpose of this study was to evaluate the applicability of c onservative management of complications related to the creation of the continent ileocolonic reservoir Miami pouch. STUDY DESIGN: Patients w ho underwent creation of the Miami pouch at the Division of Gynecologi c Oncology, University of Miami School of Medicine, since 1988 have be en included in this study. Management of complications, with particula r emphasis on the conservative treatment, has been reviewed in detail for each patient. Open surgery and conservative treatment have been co mpared. RESULTS: Seventy-seven patients underwent creation of the Miam i pouch from February 1988 to September 1997. Sixty (77.9%) patients w ere affected by recurrent cervical cancer; 72 (93.5%) were previously radiated. The perioperative mortality rate was 11.7% (9 patients). Six of these patients died as a result of sepsis; all of them underwent r eoperation at least once. The most common urinary complications were u reteral stricture or obstruction (22.1%), difficult catheterization (1 9.5%), and pyelonephritis (13%). Conservative management strategies us ed for these complications included percutaneous nephrostomy, stent pl acement, balloon dilatation, radiologically (ultrasonography, fluorosc opy, computed tomography) guided placement of catheters, and antibioti c treatment. Eighty percent of the complications associated with the i leocolonic reservoir were resolved with conservative treatment, wherea s 16.9% required surgical revision. CONCLUSION: On the basis of these findings, conservative management of urinary reservoir complications s hould always be considered before surgical intervention is attempted. The exact time to engage in open revision should be individualized on the basis of the clinical condition of each patient. It is our belief that the conservative approach should be instituted whenever possible but surgical intervention not be delayed when absolutely indicated.