Continent urinary diversion and low-rectal anastomosis in patients undergoing exenterative procedures for recurrent gynecologic malignancies

Objective. The aim of this study was to review the complications associated with continent urinary diversion and associated procedures in patients wit h gynecologic malignancies. Methods. We retrospectively reviewed the medical records of all patients wh o underwent construction of a continent urinary conduit between October 199 1 and October 1998 on the Gynecology Service at Memorial Sloan-Kettering Ca ncer Center. Results. Thirty-three patients were identified, of whom 22 underwent total pelvic exenteration, 8 underwent anterior exenteration, and 3 underwent uri nary diversion procedures only. Complications associated with the urinary d iversion procedure included ureteral strictures (2), pouch leakage (2), mil d hydronephrosis, (6), pyelopnephritis (2), nocturnal incontinence (5), and difficulty with self-catherization (2). Additional procedures performed co ncomitantly with continent urinary diversion and exenteration included pelv ic reconstruction (18), low-rectal anastomosis (13), and intraoperative rad iation therapy (9). The most significant morbidity was seen in patients und ergoing concomitant low-rectal anastomosis, in whom the rate of anastomotic leaks was 54% (7 of 13 patients). Conclusions. Continent urinary diversion can successfully be accomplished a t the time of exenteration in patients with recurrent gynecologic malignanc ies. The rate of major complications related to the urinary diversion is sm all and most complications can be managed nonsurgically. The greater than 5 0% rate of anastomotic leaks in patients undergoing concomitant low-rectal anastamosis suggests that such anastomosis should not be undertaken in this group of patients. (C) 2000 Academic Press.