Highlights:
- •Double-barrelled wet colostomy presents advantages like the single stoma placement and the simplicity of the technique.
- •There are no differences in the rate of complications between double-barrelled wet colostomy and Bricker ileal conduit.
- •The long-term complications related to urinary diversion remain high despite the type of technique.
- •The DFS and OS after 48 months of follow up was 51 % and 58 % respectively.
Abstract
Background
After exhausting other therapeutic options, pelvic exenteration is performed in patients
who suffer from relapsed gynaecologic tumours, with most of them requiring some sort
of urinary diversion.
Material and methods
The main objective of this study was to assess the short- and medium/long-term urinary
complications associated with the Bricker ileal conduit versus double-barrelled wet
colostomy after performing a pelvic exenteration for gynaecologic malignancies.
Results
A total of 61 pelvic exenterations were identified between November 2010 and April
2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included
in the urinary diversion analysis. Regarding the specific short-term urinary complications,
no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy
complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or
urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal
conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific
medium/long-term urinary complications. No differences in the rates of pyelonephritis
(59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture
(10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal
failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were
found.
Conclusions
There are no significant differences in the rate of complications between double-barrelled
wet colostomy and the Bricker ileal conduit. The long-term complications related to
urinary diversion remained high regardless of the type of technique. In this context,
the double-barrelled wet colostomy presents advantages such as the single stoma placement
and the simplicity of the technique.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pelvic exenteration in gynecologic cancer: complications and oncological outcome.Gynecol Surg. 2019; 16
- Pelvic exenteration in the age of modern chemoradiation.Gynecol Oncol. 2011; 121: 131-134
- Pelvic exenteration for advanced pelvic malignancies.Ann Surg Oncol. 2006; 13: 612-623
- Pelvic exenterations for gynecological malignancies: twenty-year experience at Roswell Park Cancer Institute.Int J Gynecol Cancer. 2005; 15: 475-482
- Major complications of urinary diversion after pelvic exenteration for gynecologic malignancies: a 23-year mono-institutional experience in 124 patients.Gynecol Oncol. 2004; 92: 680-683
- Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA.Gynecol Oncol. 2005; 99: 153-159
- Overall survival after pelvic exenteration for gynecologic malignancy.Gynecol Oncol. 2014; 134: 546-551
- Predictors for lomg term survival after interdisciplinary surgery for advanced or recurrent gynecologic cancers.J Surg Oncol. 2007; 95: 474-484
- Pelvic exenteration for gynecologic malignancies: Postoperative complications and oncologic outcomes.Actas Urol Esp (Engl Ed). 2018 Mar; 42: 121-125
- Pelvic exenteration: ten-year experience at the European Institute of Oncology in Milan.Gynecol Oncol. 2009; 114: 64-68
- Urinary diversion after pelvic exenteration for gynecologic malignancies.Int J Gynecol Cancer. 2021 Jan; 31: 1-10
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- The surgical treatment of cancer of the cervix uteri; a radical operation for cancer of the cervix.Bull N Y Acad Med. 1949; 4: 418-419
- Simultaneous diversion of the urinary and fecal streams utilizing a single abdominal stoma: the double-barreled wet colostomy.J Urol. 1989; 141: 1189-1191
- Complications after double-barreled wet colostomy compared to separate urinary and fecal diversion during pelvic exenteration: time to change back?.Gynecol Oncol. 2013; 128: 60-64
- Double-barreled colon conduit and colostomy for simultaneous urinary and fecal diversions: long-term follow-up.Ann Surg Oncol. 2014 Dec; 21: S522-S527
- Single institution experience comparing double-barreled wet colostomy to ileal conduit for urinary and fecal diversion.Urology. 2011; 78: 856-862
- Double-Barreled Wet Colostomy versus Ileal Conduit and Terminal Colostomy for Urinary and Fecal Diversion: A Single Institution Experience.Scand J Surg. 2014; 103: 189-194
- Literature Review: Double-Barrelled Wet Colostomy (One Stoma) versus Ileal Conduit with Colostomy (Two Stomas).Urol Int. 2017; 98: 249-254
Article info
Publication history
Published online: January 22, 2023
Accepted:
January 20,
2023
Received in revised form:
January 9,
2023
Received:
September 1,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
