Pd21-02 Management of Complications of Ileal or Colonic Conduits Following Pelvic Exenteration

You have accessJournal of UrologyReconstruction: Augmentation, Substitution, Diversion (PD21)1 May 2024PD21-02 MANAGEMENT OF COMPLICATIONS OF ILEAL OR COLONIC CONDUITS FOLLOWING PELVIC EXENTERATION Catalina A. Palma, Charlotte van Kessel, Scott Leslie, David Eisinger, Arthur Vasilaras, Paul Sved, Peter Lee, Kirk Austin, Michael Solomon, and Nicola Jeffery Catalina A. PalmaCatalina A. Palma , Charlotte van KesselCharlotte van Kessel , Scott LeslieScott Leslie , David EisingerDavid Eisinger , Arthur VasilarasArthur Vasilaras , Paul SvedPaul Sved , Peter LeePeter Lee , Kirk AustinKirk Austin , Michael SolomonMichael Solomon , and Nicola JefferyNicola Jeffery View All Author Informationhttps://doi.org/10.1097/01.JU.0001008888.07102.14.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic exenteration (PE) can potentially be curative in advanced pelvic malignancies. When cystectomy is required, urinary reconstruction is typically performed with the formation of ileal or colonic conduit. Urological complications following urinary reconstruction include anastomotic strictures and urine leaks. Urine leaks can be a devastating long term complication, adding significant length to inpatient and outpatient management and impacting quality of life. The aim of this study was to assess the presentation, diagnosis and management of urological complications post PE with a focus on urinary leaks. METHODS: This was a cohort study of patients who had PE at a single centre (1998 to 2021). Patients were identified from a prospectively maintained database. Outcomes were post-operative complications and diagnosis methods employed to detect these. Interventions (surgical and radiological) used to manage complications were examined in detail. RESULTS: 419 patients were enrolled. 60% of patients had PE for rectal cancer. 70 patients suffered conduit-related complications. Ileal conduits had lower complication rates than colonic conduits (24% vs 42%, p=0.029). Patients with conduit complications had more extensive surgery with significantly higher intraoperative blood loss and longer length of surgery. Urinary complications included: uretero-intestinal anastomotic strictures (31), urine leak originating from conduit body defect (22), urine leak from uretero-intestinal anastomosis (16), nephrolithiasis (9), parastomal hernia (6), distal conduit stenosis (5), distal conduit ischemia (5), malignant ureteric strictures from tumour recurrence (5), hemorrhage from conduit (4). Urinary leaks from anastomosis were initially managed with percutaneous nephrostomy diversion, with 2/16 requiring open surgical primary repair due to persistence of leak, 2 patients required permanent nephrostomy tubes, and 2 developed post-leak anastomotic strictures. Urine leaks from the conduit body were resistant to percutaneous management in 21/22 cases. 12 patients required open surgical primary repair, 7 patients (with large fistulas) required complete refashioning of new conduit, and 3 patients required permanent nephrostomy tubes. CONCLUSIONS: Urine leaks from ileal/colonic conduits present the heaviest urological complication burden to PE patients. While anastomotic leaks were successfully managed percutaneously in most cases, urine leaks from a defect in the conduit body required surgical management with primary repair or reconstruction of the conduit. Source of Funding: No external funding or support was received for this study © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e453 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Catalina A. Palma More articles by this author Charlotte van Kessel More articles by this author Scott Leslie More articles by this author David Eisinger More articles by this author Arthur Vasilaras More articles by this author Paul Sved More articles by this author Peter Lee More articles by this author Kirk Austin More articles by this author Michael Solomon More articles by this author Nicola Jeffery More articles by this author Expand All Advertisement PDF downloadLoading ...