Postoperative outcomes after continent versus incontinent urinary diversion at the time of pelvic exenteration for gynecologic malignancies

Objective To compare outcomes of patients undergoing continent or incontinent urinary diversion after pelvic exenteration for gynecologic malignancies. Methods Data on patients who underwent pelvic exenteration for gynecologic malignancies at The University of Texas MD Anderson Cancer Center between January 1993 and December 2010 were collected. A multivariate logistic regression model was used and statistical significance was P < 0.05. Results A total of 133 patients were included in this study. The mean age at exenteration was 47.6 (range, 30-73) years in the continent urinary diversion group and 57.2 (range, 27-86) years in the incontinent urinary diversion group (P < 0.0001). Forty-six patients (34.6%) had continent urinary diversion, and 87 patients (65.4%) had incontinent urinary diversion. The rates of postoperative complications in patients with continent and incontinent urinary diversion, respectively, were as follows: pyelonephritis, 32.6% versus 37.9% (P = 0.58); urinary stone formation, 34.8% versus 2.3% (P < 0.001); renal insufficiency, 4.4% versus 14.9% (P = 0.09); urostomy stricture, 13.0% versus 1.2% (P = 0.007); ureteral (anastomotic) leak, 4.4% versus 6.9% (P = 0.71); ureteral (anastomotic) stricture, 13.0% versus 23% (P = 0.25); fistula formation, 21.7% versus 19.5% (P = 0.82); and reoperation because of complications of urinary diversion, 6.5% versus 2.3% (P = 0.34). Among patients with continent urinary diversion, the incidence of incontinence was 28.3%, and 15.2% had difficulty with self-catheterization. Conclusion There were no differences in postoperative complications between patients with continent and incontinent conduits except that stone formation was more common in patients with continent conduits.