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[Supralevator pelvic exenteration with simultaneous bowel and urinary reconstruction. Two case reports]
K Obara1, T Nishiyama, M Takeda
1Department of Urology, Niigata University, School of Medicine.
Summary
Supralevator pelvic exenteration successfully preserved voiding and evacuation functions in two male patients with advanced tumors. Both patients achieved voluntary defecation and urination with low urinary pouch pressure post-surgery.
Area of Science:
- Urology
- Surgical Oncology
- Reconstructive Surgery
Background:
- Pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies.
- Preserving lower urinary and rectal functions after pelvic exenteration presents significant reconstructive challenges.
- Novel surgical techniques are crucial for improving quality of life in patients undergoing such extensive resections.
Observation:
- Two male patients, aged 19 and 39, with advanced pelvic tumors underwent supralevator pelvic exenteration.
- Case 1 involved a pineal region tumor with metastasis to the rectovesical pouch.
- Case 2 presented with a bulky retrovesical tumor.
Findings:
- Both patients underwent successful supralevator pelvic exenteration with preservation of normal voiding and evacuating function.
- Reconstructive techniques included double pouches (colonic J pouch and Mainz pouch to urethra) and sigmoid colo-proctostomy with U-pouch to urethra.
- Post-operatively, both patients achieved urinary and fecal continence, with only minor nocturnal urinary leakage. Urodynamic studies indicated low pressure within the urinary pouches.
Implications:
- Supralevator pelvic exenteration is a viable option for selected male patients with advanced pelvic tumors.
- Advanced reconstructive techniques can effectively restore urinary and fecal functions, significantly enhancing patient quality of life.
- Further research into long-term outcomes and functional preservation following these complex procedures is warranted.