URINARY DIVERSION IN GYNECOLOGIC ONCOLOGY

Abstract

Urinary diversion in gynecologic oncology is used primarily in patients undergoing anterior or total pelvic exenterations for recurrent cancers of the female reproductive tract. In most cases, patients undergo an exenterative procedure with urinary diversion after failed radiation therapy. Rarely, exenterations are performed as the primary treatment for gynecologic malignancies or for nonradiated recurrent cancers. Urinary diversion in women also may be necessary in managing urinary fistulas or relieving ureteral obstruction related to radiation for pelvic tumors. Familiarity with such procedures is essential for gynecologic oncologists and other pelvic surgeons who deal constantly with the treatment and management of genital tract malignancies and complicated gynecologic cases. This article discusses the development of diversionary procedures, the specific indications and complications for such procedures, and the techniques of performing conduits and one of the most commonly used continent urinary diversions in gynecologic oncology, the Miami pouch.