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  • Title: Ileal orthotopic neobladder after pelvic exenteration for cervical cancer.
    Author: Chiva LM, Lapuente F, Núñez C, Ramírez PT.
    Journal: Gynecol Oncol; 2009 Apr; 113(1):47-51. PubMed ID: 19176235.
    Abstract:
    OBJECTIVE: We aimed to describe our preliminary experience in creating an ileal orthotopic urinary conduit in patients with a history of pelvic irradiation undergoing pelvic exenteration for recurrent cervical cancer and to evaluate the feasibility, complication rates, and outcomes of this procedure. METHODS: A retrospective chart review was performed in all 6 patients who underwent ileal orthotopic neobladder creation at our institution between January 2005 and March 2008. Main outcome measures were surgical complications, continence rate, neobladder function, and oncologic outcome. RESULTS: The mean patient age was 46.6 years (range, 38-61). Four patients underwent anterior exenteration and 2 total pelvic exenterations. There were no intraoperative complications. The median operative time was 456 min (range, 372-600). The median time to create the orthotopic urinary conduit was 70 min (range, 55-90). Three patients had postoperative neobladder anastomotic leak. Two of them had this complication successfully managed conservatively and 1 surgically. Daytime urinary continence was good or satisfactory in 4 of 6 patients. Nighttime urinary continence was good or satisfactory in 3 of 6 patients. All patients reported being satisfied with their decision to undergo this procedure. Median follow-up time was 20.5 months (range, 6-34). At last visit, 3 patients were alive without evidence of disease, 1 was alive with stable retroperitoneal disease, and 2 had died of disease recurrence after exenteration. CONCLUSIONS: Ileal orthotopic neobladder creation in patients undergoing exenteration for recurrent cervical cancer is feasible after radiation. The rate of urinary continence is acceptable.
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