Urological complications and renal function outcomes following total pelvic clearance: A five-year retrospective cohort study.

BACKGROUND

Total Pelvic Clearance (TPC) is an aggressive surgical procedure developed to manage recurrent or advanced neoplastic disease in the pelvic area. Although it provides definitive treatment, it has been associated with a high rate of urological complications.

METHODS

A retrospective cohort analysis was conducted at a referral oncological centre involving 92 patients who underwent total pelvic clearance (TPC) between 2019 and 2023. Data were extracted from institutional electronic medical records. Demographic, clinical, and surgical parameters were documented. Urological complications, including hydronephrosis, anastomotic leak, anastomotic stenosis, urostomy stenosis, parastomal hernia, and recurrent urinary tract infections (UTIs), and their association with various demographic, clinical, and surgical factors were evaluated. The decline in renal function was determined by the percentage reduction in postoperative estimated glomerular filtration rate (eGFR) over a one-year period. The management of complications was also reported.

RESULTS

Out of 92 patients who had Total Pelvic Clearance (TPC), urological complications occurred in 43 (47.1%). The most common issues were hydronephrosis in 19 patients (20.7%) and anastomotic stenosis in 13 patients (14.1%). Anastomotic leaks and recurrent urinary tract infections each affected 6 patients (6.5%). Parastomal hernias and urostomy stenoses were less common, occurring in 2.2% and 1.1%, respectively. There was no significant association between complications and radiotherapy, chemotherapy, or disease recurrence, although hydronephrosis was more common in recurrent cases (84.2% vs. 63%, p = 0.079). The average decline in renal function was 12.9% ± 17.0% at one year. Most complications were managed conservatively or with minimally invasive procedures; only two patients required surgical revision.

CONCLUSION

Hydronephrosis and anastomotic stenosis remain the most common urological complications after TPC, often leading to a decline in renal function. Most cases were successfully managed conservatively or through image-guided intervention, supporting a stepwise, minimally invasive approach that protects renal function and avoids unnecessary reoperations.