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EP758 Comparison of outcomes with ileal and colonic incontinent urinary conduits in and irish gynaecological oncology centre
  1. S Varghese,
  2. N Gleeson and
  3. C Thompson
  1. St James’s Hospital/Trinity College Dublin, Dublin, Ireland


Introduction/Background A comprehensive tertiary gynaecological surgical oncology service includes urinary diversion as part of exenterative surgery and to treat fistulae. Many patients have received pelvic radiotherapy that can adversely and progressively affect the small bowel over a lifetime. As a result there has been a move to colonic conduits in the expectation that there may be less long term adverse sequelae.

Methodology Retrospective review of all patients undergoing incontinent conduit formation from Jan 2011–Dec 2017. Major adverse outcomes (MAO) were categorised as immediate (<4weeks), short term (<6 months) or long-term (>6 months) following surgery.

Results Of 27 patients, 18 (66%) had isolated colonic segment and 9 (33%) ileal segment fashioned as urinary conduit.

Immediate MAO: Ureteric anastomotic leak (1 ileal, 0 colonic conduits); Re-laparotomy for adhesional small bowel obstruction (0 ileal, 2 colonic conduits).

Short term MAO: Ureteric obstruction requiring ureteric stenting/nephrostomy (4 ileal, 3 colonic conduits).

Long term MAO: Stomal stenosis (2 ileal, 0 colonic conduits); Recurrent sepsis requiring IR/surgical intervention (3 ileal, 1 colonic conduit); Interval small bowel obstruction (0 ileal, 3 colonic conduits); Nephrectomy (1 ileal, 0 colonic conduits).

Conclusion The absence of anastomotic leaks and stomal stenosis and lower rates of ureteric obstruction even in the short-term (17% vs 44%) with colonic conduits support the view that a colonic segment is less likely to be compromised by prior radiotherapy and is therefore the better choice for urinary diversion in gynaecological cancer care. However, the rate of adhesional small bowel obstruction was substantial with colonic conduits and this requires further analysis. Retrospective review is compromised by patient selection and operator choice. For now, our centre recommends colonic urinary conduit as standard of care.

Disclosure Nothing to disclose.

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