Double barrelled uro‐colostomy versus Ileal conduit for urinary diversion following pelvic exenteration: a single centre experience

Abstract

AbstractIntroductionThe ideal method for urinary diversion following total pelvic exenteration (TPE) remains unclear. This study compares the outcomes of double‐barrelled uro‐colostomy (DBUC) and ileal conduit (IC) in a single Australian centre.MethodsAll consecutive patients who underwent pelvic exenteration with the formation of either a DBUC or an IC between 2008 and November 2022 were identified from the prospective database from the Royal Adelaide Hospital and St. Andrews Hospital. Demographic, operative characteristics, general perioperative, long‐term urological and other relevant surgical complications were compared via univariate analyses.ResultsOf 135 patients undergoing exenteration, 39 patients were eligible for inclusion: 16 patients with a DBUC, and 23 patients with an IC. More patients in the DBUC group had previous radiotherapy (93.8% vs. 65.2%, P = 0.056) and flap pelvic reconstruction (93.7% vs. 45.5%, P = 0.002). The rate of ureteric stricture trended higher in the DBUC group (25.0% vs. 8.7%, P = 0.21), but in contrast, urine leak (6.3% vs. 8.7%, P>0.999), urosepsis (43.8% vs. 60.9%, P = 0.29), anastomotic leak (0.0% vs. 4.3%, P>0.999), and stomal complications requiring repair (6.3% vs. 13.0%, P = 0.63) trended lower. These differences were not statistically significant. Rates of grade III or greater complications were similar; however, no patients in the DBUC group died within 30‐days or had grade IV complications requiring ICU admission compared with two deaths and one grade IV complication in the IC group.ConclusionDBUC is a safe alternative to IC for urinary diversion following TPE, with potentially fewer complications. Quality of life and patient‐reported outcomes are required.