Major complications of urinary diversion after pelvic exenteration for gynecologic malignancies: a 23-year mono-institutional experience in 124 patients

Gynecol Oncol. 2004 Feb;92(2):680-3. doi: 10.1016/j.ygyno.2003.11.003.


Objective: The objective of this study was to analyze the postoperative outcome of patients undergoing urinary diversion at the time of pelvic exenteration.

Methods: Between January 1980 and December 2002, 232 pelvic exenterations for gynecologic malignancies were performed in our hospital. One hundred and twenty-four included a urinary diversion. There were locally advanced or recurrent cancers including 101 cervical, 11 endometrial, 5 vagina, 2 ovarian malignancies and 5 pelvic sarcoma.

Results: Ninety patients (72.5%) had a history of previous irradiation. Exenterations were 69 anterior and 55 total. Urinary diversion included 14 bilateral ureterostomies, 62 trans-intestinal diversion and 48 continent diversion using distal ileum and right colon. Pelvic filling was performed in 56 patients (45%). Low colorectal anastomosis was performed in 42 of 48 supralevator pelvic exenteration (87.5%). Postoperative mortality rate was 8% (10/124). Overall 12-week postoperative morbidity rate was 52% (65/124) and appears to be significantly higher in irradiated patients and after total exenteration. In trans-intestinal noncontinent group, eight patients were reoperated for a complication directly related to urinary diversion procedure. No reoperation for such a complication was performed in the continent urinary diversion group.

Conclusions: Ileocolic continent pouch seems to be the safer urinary diversion procedure after exenteration for gynecological malignancies especially in irradiated patients and after total exenteration.

MeSH terms

  • Adult
  • Aged
  • Female
  • Genital Neoplasms, Female / surgery*
  • Humans
  • Middle Aged
  • Pelvic Exenteration / methods*
  • Retrospective Studies
  • Treatment Outcome
  • Urinary Diversion / adverse effects*