[Continent urinary diversion following anterior exenteration]

Area of Science:

• Oncology
• Urology
• Surgical Innovation

Context:

• Pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies.
• Urinary diversion is a critical component impacting post-operative quality of life.
• Two main categories of urinary diversion exist: incontinent and continent.

Purpose:

• To review the indications and considerations for continent urinary diversion in women undergoing pelvic exenteration.
• To highlight the importance of selecting appropriate urinary diversion techniques based on tumor characteristics and treatment plans.
• To emphasize the need for multidisciplinary collaboration in managing complex gynecological cancer cases requiring exenteration.

Summary:

• Continent urinary diversion, including orthotopic neobladder and rectal reservoir, is indicated for invasive bladder cancer and advanced/recurrent gynecological tumors.
• For patients with non-irradiated bladder cancer, orthotopic neobladder or rectal reservoir are viable options.
• In cases involving preoperative radiotherapy, non-irradiated bowel segments are recommended for diversion; for planned postoperative radiation, diversion must be outside the radiation field.

Impact:

• Informed patient selection of urinary diversion can significantly improve quality of life post-exenteration.
• Centralization of care in high-volume, multidisciplinary centers improves outcomes for patients with advanced gynecological cancers.
• Objective discussion of urinary diversion advantages and disadvantages empowers patients in their treatment journey.