Urological complications following pelvic exenteration are comparable to those following radical cystectomy

Radical cystectomy and urinary diversion is required for both primary muscle-invasive bladder cancer and in the setting of pelvic exenteration for advanced malignancy of pelvic organs. Acute and chronic complications following radical cystectomy can be a significant cause of morbidity. We compared the rates of urological complications following these two procedures at our tertiary referral centre.

Patients who underwent radical cystectomy and urinary diversion either alone or as part of pelvic exenteration between June 2017 and April 2024 at our hospital were included. Short and long-term post-operative urological complications were collected, and data for patients who underwent PE were collected prospectively as part of a larger database.

One hundred eleven patients underwent cystectomy: 44 as part of pelvic exenteration (PE), 67 cystectomy alone. Post-operative urological complications occurred in 45% of patients undergoing PE and 42% undergoing cystectomy alone (P = 0.703). Urosepsis was the most frequent complication in both cohorts, occurring in 27% and 24% of patients who underwent PE and cystectomy alone respectively. Return to theatre was required in 9% of PE patients and 7% of non-PE patients. ASA status was predictive of complication development in the non-PE cohort, no factors analysed were predictive in the PE cohort.

In this cohort, the rate of urological complications and return to the theatre following radical cystectomy and urinary diversion were comparable among those undergoing PE and cystectomy alone. No individual factor was identified that was predictive of post-operative complications.