Indiana Pouch for the Treatment of Pelvic Tumors and their Aftermaths: A 20-Year Experience at the National Cancer Institute
Keywords:
Urinary diversion, colonic pouches, hydronephrosisAbstract
Objective: To evaluate the renal function and side effects of the Indiana pouch at the National Cancer Institute of Colombia.
Method: 75 cases with history of Indiana Pouch reconstructive surgery were recruited from June 1987 to June, 2008.
Results: 36 bladder; 35 uterine cancer; 1 vulvar cancer, vaginal cancer, 2 melanomas; and 1 osteoclastoma were included. The Indiana Pouch was used in 35 radical cystectomies, and 14 pelvic exenterations. In 26 cases, there was non-surgical tumor extirpation. 95% of patients continued with proper renal function and normal serum electrolytes. Complete continence was present in 92% of cases. The average reservoir capacity was 536.5ml; 22 (24.7%) healthy kidneys were lost after re-implantation. In contrast, 22 (56.4%) hydro-nephronic kidneys became healthy. Early complications were present in 6.66% of cases; and late complications in 46.70%. Early re-intervention was observed in 8.0%; late, 40.1%. Perioperative mortality was 8.0%; cumulative mortality, 45.3%. The average survival was 30.7 months.
Conclusions: The Indiana Pouch is a useful urinary device when urethra preservation is not possible. Complications occur late rather than early. Hydronephrosis, parenchymatic damage and neo-cystolytiasis were frequent in this series, wherein 48% of patients were irradiated.
Author Biographies
Ricardo López Gil, Instituto Nacional de Cancerología
Clínica de Urología del Instituto Nacional de Cancerología, Bogotá, Colombia.
Felipe Zamora, Instituto Nacional de Cancerología
Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá, Colombia.
Jorge Daniel Anzola, Instituto Nacional de Cancerología
Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá, Colombia.
César Lemos, Universidad El Bosque
Departamento de Urología, Universidad El Bosque, Bogotá, Colombia.
Nelson Rodríguez
Matemático. Bogotá, Colombia.
References
Benson MC, Olson CA. Continent urinary diversion. En: Wein AJ, Kavoussi LR. Campbell's-Walsh urology, 7th ed. Philadelphia: Elsevier Saunders, 2000; pp. 3190-245.
Burgers JK, Brendler CB. Anatomic radical cystoprostatectomy. Urol Clin North Am. 1991;18(4):659-76.
Light JK, Scardino PT. Radical cystectomy with preservation of sexual and urinary function. Urol Clin North Am. 1986;13(2):261-9.
Marshall FF Treiger BF. Radical cystectomy (anterior exenteration) in the female patient. Urol Clin North Am. 1991;(18)4:765-75.
Marnitz S, Köhler C, Müller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol. 2006;103(3):1023-30.
https://doi.org/10.1016/j.ygyno.2006.06.027
López MJ, Luna-Pérez P. Composite pelvic exenteration: is it worthwhile? Ann Surg Oncol. 2004;11(1):27-33.
https://doi.org/10.1007/BF02524342
Dreyer G, Snyman LC, Mouton A, Lindeque BG. Management of recurrent cervical cancer. Best Pract Res Clin Obstet Gynaecol. 2005;19(4):631-44.
https://doi.org/10.1016/j.bpobgyn.2005.03.003
Angioli R, Panici PB, Mirhashemi R, Mendez L, Cantuaria G, Basile S, et al. Continent urinary diversion and low colorectal anastomosis after pelvic exenteration. Quality of life and complication risk. Crit Rev Oncol Hematol. 2003;48(3):281-5.
https://doi.org/10.1016/S1040-8428(03)00126-4
Hinman F. This month in Investigative Urology: Urinary reservoirs and pelvic malignancy. J Urol. 1989;141(5):1216-1289.
https://doi.org/10.1016/S0022-5347(17)41223-7
Rowland RG, Mitchell ME, Bihrle R, Kahnoski RJ, Piser JE. Indiana continent urinary reservoir. J Urol. 1987;137(6):1136-9.
https://doi.org/10.1016/S0022-5347(17)44428-4
Ahlering TE, Weinberg AC, Razor B. Modified Indiana pouch. J Urol. 1991;145(6):1156-8.
https://doi.org/10.1016/S0022-5347(17)38561-0
McDougal WS. Bladder reconstruction following cistectomy by uretero-ileo-colourethrostomy. J Urol. 1986;135(4):698-701.
https://doi.org/10.1016/S0022-5347(17)45822-8
Höckel M. Laterally extended endopelvic resection. Novel surgical treatment of locally recurrent cervical carcinoma involving the pelvic side wall. Gynecol Oncol. 2003;91(2): 369-77.
https://doi.org/10.1016/S0090-8258(03)00502-X
McDougal WS. Metabolic complications of urinary intestinal diversion. J Urol. 1992;147(5):1199-208.
https://doi.org/10.1016/S0022-5347(17)37517-1
Nabi G, Yong SM, Ong E, McPherson G, Grant A, N'Dow J. Is orthotopic bladder replacement the new gold standard? Evidence from a systematic review. J Urol. 2005;174(1):21-8.
https://doi.org/10.1097/01.ju.0000162021.24730.4f
Webster CH, Bukkapatnam R, Seigne JD, Pow-Sang J, Hoffman M, Helal M, et al. Continent colonic urinary reservoir (Florida Pouch): long term surgical complications (greater than 11 years). J Urol. 2003;169(1):174-6.
https://doi.org/10.1016/S0022-5347(05)64061-X
Dahl DM, Mcdougal WS. Use of intestinal segments in urinary diversion. En: Wein AJ, Kavoussi LR. Campbell-Walsh urology, 9th ed. Philadelphia: Elsevier Saunders; 2007.
Scheidler DM, Rowland RG. Update on the Indiana continent urinary reservoir. J Urol. 1989;141:302 A.
Mitchell C, Benson. Urinary diversions. En: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (editors). Campbell-Walsh urology. 8a. ed. Philadelphia: Elzevier, 2002; pp. 4181-7.
Bejany D, Suarez G, Penalver M, Politano V. Nontunneled Ureterocolonic anastomosis. An alternative to the implantation. J Urol. 1989;142(4):961-3.
https://doi.org/10.1016/S0022-5347(17)38953-X
Wilson T, Moreno J, Weinberg A, Ahlering T. Late complications of modif ied Indiana pouch. J Urol. 1994;151(2):331-4.
https://doi.org/10.1016/S0022-5347(17)34940-6
Salom EM, Mendez LE, Schey D, Lambrou N, Kassira N, Gómez-Marn O, et al. Continent ileocolonic urinary reservoir (Miami pouch): The University of Miami experience over 15 years. Am J Obstet Gynecol. 2004;190(4):994-1003.
https://doi.org/10.1016/j.ajog.2004.01.023
Zoubek J, McGuire EJ, Noll F, DeLancey JO. The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma. J Urol. 1989;141(6):1347-9.
https://doi.org/10.1016/S0022-5347(17)41303-6
Hautman RE. Urinary diversion: Ileal conduit to neobladder. J Urol. 2003;169(3):834-42.
https://doi.org/10.1097/01.ju.0000029010.97686.eb
Vásquez NC. Derivación urinaria en exenteracion pélvica. Tesis de grado. Instituto Nacional de Cancerología. 2007.
World Health Organization (WHO) Consensus Conference on Bladder Cancer, Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, et al. Urinary Diversion. Urology. 2007;69(1 Suppl):17-49.
https://doi.org/10.1016/j.urology.2006.05.058
Nagele U, Sievert K, Merseburger A, Anastasiadis A, Stenzl A. Urinary diversion following cystectomy. EAU Update Series. 2005;3(3): 129-37.
https://doi.org/10.1016/j.euus.2005.07.003
Penalver MA, Angioli R, Mirhashemi R, Malik R. Management of early and late complications of ileocolonic continent urinary reservoir (Miami pouch). Gynecol Oncol. 1998;69(3):185-91.
https://doi.org/10.1006/gyno.1998.4981
Wydra D, Emerich J, Sawicki S, Ciach K, Marciniak A. Major complications following exenteration in cases of pelvic malignancy: A 10-year experience. World J Gastroenterol. 2006;12(7):1115-9.
https://doi.org/10.3748/wjg.v12.i7.1115
McDougal WS. Use of intestinal segments and urinary diversión. En: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (editors). Campbell-Walsh urology. 7a. ed. Philadelphia: Elzevier, 1998; pp. 3155-6.
Glenn JF. Complication of indiana pouch. Urol Surg. 1983;137:1131-5.
Parekh DJ, Donat SM. Urinary diversion: options, patients, selection, and outcomes. Semin Oncol. 2007;34(2):98-109.
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