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Continent urinary diversion in gynecologic oncology
M A Penalver1, D E Bejany, H E Averette
1Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida 33101.
Gynecologic Oncology
|September 1, 1989
Summary
This study introduces a novel continent urinary diversion using a colonic reservoir for gynecologic cancer patients, achieving urinary continence after pelvic exenteration. This method offers a low-pressure system and avoids urine incontinence.
Area of Science:
- Gynecologic Oncology
- Urology
- Surgical Innovation
Background:
- Pelvic exenteration for recurrent gynecologic cancer often results in urinary incontinence.
- Traditional urinary diversion methods (ileal or colon conduit) have limitations.
Purpose of the Study:
- To report on a new continent urinary diversion procedure for gynecologic cancer patients undergoing pelvic exenteration.
- To evaluate the efficacy and safety of a colonic reservoir with ileocecal valve continence mechanism.
Main Methods:
- A continent urinary diversion was created using a detubularized segment of ileum, ascending colon, and transverse colon.
- The ileocecal valve was modified with purse-string sutures for continence.
- Ureterocolonic anastomoses were performed without tunneling.
- Patients were catheterized through an exteriorized ileal stoma.
Main Results:
- Nine patients with gynecologic carcinoma underwent the procedure.
- Postoperative urodynamic studies showed a reservoir capacity of 750 ml.
- All patients achieved urinary continence.
- Radiographs confirmed no reflux.
Conclusions:
- The described colonic reservoir provides a capacious, low-pressure system for continent urinary diversion.
- This innovative technique shows promise for improving quality of life in gynecologic cancer patients.
- Further clinical trials are warranted to validate these findings.