INCIDENCE AND TREATMENT OF UROLOGICAL COMPLICATIONS AFTER TOTAL PELVIC EXENTERATION FOR ADVANCED PELVIC TUMORS

Czech version

Authors: Jaroslav Jarabák ¹; Roman Zachoval ¹; Vladimír Visokai ²; Jaromír Šimša ²; Ludmila Lipská ²; Miroslav Levý ²
Authors‘ workplace: Urologické oddělení, Thomayerova nemocnice, Praha ¹; Chirurgická klinika 1. lékařské fakulty Univerzity Karlovy a Thomayerovy nemocnice, Praha ²
Published in: Ces Urol 2016; 20(1): 39-47
Category: Original Articles

Overview

Major statement:
Total pelvic exenteration is an extensive performance with a high incidence of urological complications. The acute solution is urinary nephrostomy and once the patient is in remission then proceeding to stent or reanastomosis. The aim: To evaluate the incidence of urological complications in patients after total pelvic exenteration for advanced tumors of the small pelvis.

Material and methods:
Retrospective evaluation of patients who underwent a total pelvic exenteration in our hospital in 1999–2013. We evaluated: oncologic characteristics of the initial tumor, previous operations, neoadjuvant therapy, previous urological disease and related surgery, length of surgery, blood loss, type and duration of urological complications and their solutions.

Results:
A total of 42 patients, 28 men (67 %) and 14 women (33 %), average age 58 years (range 43–71). Urinary diversion was performed in 41 patients by ureteroileostomy, in one case by skin ureterostomy. Urological complications were detected in 12 patients (29 %), in four early and late in eight patients. Early complications included three patients with urinary leakage from the ureteroileoanastomosis, in one patient sepsis proven by an isolated urinary tract infection. Late complications were found, on average 24 months after surgery (range 4–60 months). Seven patients formed ureteric stricture in ureteroilealanastomosis. One patient experienced stricture of skin ureterostomy. The stage of cancer, previous surgeries, urological ailments, surgery length and amount of blood loss did not affect the incidence of complications. All patients with the occurrence of urological complications underwent neoadjuvant therapy.

Conclusion:
Urological complications after total pelvic exenteration occur in approximately one third of patients. Safe acute solution was to design a urinary diversion using a nephrostomy puncture. In patients with late complications at the 2.time replacement of nephrostomy for transureteral stent. Patients in long-term remission of cancer open revision with reanastomosis of the ureteroileal connection.

KEY WORDS:
Tumors of small pelvis, ureteral stricture, total pelvic exenteration, ureteroileostomy, urinary leakage.

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