Introduction: Radiation (RT) for pelvic cancer may compromise the urinary tract. Reconstruction can be challenging especially at the time of surgical removal of the tumor. As an alternative to cystectomy, enterocystoplasty (EC) +/- ureteral reimplantation or continent catheterizable channel (CCC) brings the potential benefits of preserving the LUT. We report our experience in a series of patients, all of whom had RT, to assess outcomes and complications.
Methods: This is a retrospective case series of all post-RT patients who underwent EC to reconstruct the LUT between 1994 and 2021 from one institution. Complications and functional results were recorded.
Results: 36 patients (18 women,18 men) who had prior RT for treatment of advanced or recurrent pelvic cancer were identified. 10 patients, post chemo-RT for colorectal cancer, underwent immediate reconstruction after tumour excision, which included part of the bladder +/- ureter(s) (group 1) and 26 after RT for prostate (7), gynecologic (13), colorectal (5) and liposarcoma (1) had surgery due to RT complications (group 2). Mean age at surgery was 58 yrs (median 58.5; range 33-76). All patients underwent EC and 24 (67%) had simultaneous ureteral reimplants either into an afferent intestinal limb (17) or into the bladder (7) with 16 undergoing bilateral reimplants. Reimplants were done for obstruction due to tumor (group 1) or post-RT (group 2). 8 patients in group 2 had simultaneous CCC due to devastated urethras. The median postop length of stay (LOS) was 9 days (4-25) and was significantly shorter in group 2 vs. group 1; 8 (IQR 6-10) vs. 13 (IQR 10-14) (p=0.0039). No early (within 30 days) surgical reintervention was prompted by the LUT reconstruction. After a median follow-up of 38.5 mo. (range 2-195), 9 patients (29%) required reinterventions including 4 open operations (1 parastomal hernia, 1 vesicovaginal, 2 vesico-cutaneous fistulae), 2 ureteral intestinal anastomotic stricture dilations, and 3 endoscopic bladder stone removals. Reintervention rate was similar in the groups. Renal function was preserved. 23/28 non-stoma patients void spontaneously, 3 perform intermittent catheterization (IC), and 2 have indwelling catheters. 7/8 stoma patients do IC and one is awaiting persistent vesicocutaneous fistula repair with an indwelling catheter. At last follow-up, 32/36 patients considered their LUT management to be successful.
Conclusions: Prior pelvic RT is not a contraindication to EC with or without ureteral reimplantation and/or CCC. Longer LOS was seen in the extirpative group. Acceptable functional outcomes and morbidity can be achieved.
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