[Preliminary experience with the Miami type ileocolonic urinary reservoir in the practice of oncologic gynecology].

OBJECTIVES

For many years we have used both ileal or colon conduits for urinary diversion during pelvic exenteration. Continent urinary reservoirs have replaced ileal and colon conduits as a method of urinary diversion at our institution. The aim of this study was to review the results and complications associated with continent urinary diversion in patients with gynecologic malignancies.

METHODS

We reviewed the records of 26 patients who underwent construction of a continent urinary reservoir (Miami pouch) from February 1991 to June 1994 at the Department of Gynecologic Oncology of the National Cancer Institute of Mexico (Instituto Nacional de Cancerología). Twenty-four of these patients had received radiotherapy for gynecologic malignancies.

RESULTS

An ileocolonic continent urinary reservoir (Miami pouch) was created in 26 patients, aged 38-81 years, as part of a concurrent anterior or total pelvic exenteration for primary or recurrent gynecologic malignancies (19 pts.), for the relief of a vesicovaginal fistula (3 pts.), hemorrhagic cystitis (2 pts.), or in substitution of an ileal conduit (2 pts.), with follow-up ranging from 2-54 months. Additional procedures performed concurrently with the Miami pouch and pelvic exenteration included low rectal anastomosis (11 pts.), pelvic floor reconstruction (8 pts.), and vaginal reconstruction (4 pts.). The complications associated with the reservoir included incontinence (1 pt.), ureteral strictures (3 pts.), pouch leakage (1 pt.), difficult self-catheterization (4 pts.), and urosepsis and pyelonephritis (6 pts.). One patient developed pouch stones. In this series, 95.6% of the patients were completely continent. No obstruction or reflux was noted in 92.3% of the cases. Nonsurgical management strategies used for reservoir-related complications included percutaneous nephrostomy, intravenous antibiotics, and percutaneous pouch decompression. Reoperation was required in 5 patients: one patient (early) due to a fistula, another patient required reimplantation due to obstruction, one patient with a nonfunctioning kidney underwent nephrectomy, and two patients with stoma stenosis.

CONCLUSIONS

The Miami pouch is a low-pressure continent form of urinary diversion. The continence mechanism is easy to construct and the procedure can successfully be accomplished at the time of pelvic exenteration in patients with gynecologic malignancies. The rate of major complications of the Miami pouch is small and the continent urinary diversion can be undertaken with concurrent low rectal anastomosis or vaginal reconstruction.