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

  

Authors:	Husain, A.; Curtin, J.; Brown, C.; Chi, D.; Hoskins, W.; Poynor, E.; Alektiar, K.; Barakat, R.
Article Title:	Continent urinary diversion and low-rectal anastomosis in patients undergoing exenterative procedures for recurrent gynecologic malignancies
Abstract:	Objective. The aim of this study was to review the complications associated with continent urinary diversion and associated procedures in patients with gynecologic malignancies. Methods. We retrospectively reviewed the medical records of all patients who underwent construction of a continent urinary conduit between October 1991 and October 1998 on the Gynecology Service at Memorial Sloan-Kettering Cancer Center. Results. Thirty-three patients were identified, of whom 22 underwent total pelvic exenteration, 8 underwent anterior exenteration, and 3 underwent urinary diversion procedures only. Complications associated with the urinary diversion procedure included ureteral strictures (2), pouch leakage (2), mild hydronephrosis, (6), pyelopnephritis (2), nocturnal incontinence (5), and difficulty with self-catherization (2). Additional procedures performed concomitantly with continent urinary diversion and exenteration included pelvic reconstruction (18), low-rectal anastomosis (13), and intraoperative radiation therapy (9). The most significant morbidity was seen in patients undergoing 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 at the time of exenteration in patients with recurrent gynecologic malignancies. The rate of major complications related to the urinary diversion is small and most complications can be managed nonsurgically. The greater than 50% 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.
Keywords:	adult; clinical article; treatment outcome; aged; middle aged; retrospective studies; cancer recurrence; combined modality therapy; endometrium carcinoma; intraoperative care; treatment indication; retrospective study; postoperative complication; genital neoplasms, female; urinary diversion; urinary reservoirs, continent; ovary carcinoma; gynecologic cancer; uterine cervix carcinoma; anastomosis, surgical; vulva carcinoma; rectum; vagina carcinoma; pelvic exenteration; rectum anastomosis; humans; human; female; priority journal; article
Journal Title:	Gynecologic Oncology
Volume:	78
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2000-08-01
Start Page:	208
End Page:	211
Language:	English
DOI:	10.1006/gyno.2000.5864
PUBMED:	10926804
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-0033847276&partnerID=40&md5=bb555e5522535f1d7ccaddfa97772f3d
Notes:	Export Date: 18 November 2015 -- Source: Scopus