MP61-16\u2003OUTCOMES OF URINARY DIVERSION CREATED FOR LATE ADVERSE EFFECTS OF GYNECOLOGIC RADIOTHERAPY

Abstract

INTRODUCTION AND OBJECTIVES: Severe urinary adverse effects of radiation are seen in 17% of women treated for gynecologic malignancies. This incidence continues to climb through at least 25 years post-radiation. Reconstructive options are fraught with morbidity as surgical repair of vesicovaginal fistula and radiation-induced ureteral stricture are prone to failure due to local effects of radiotherapy. Urinary diversion represents an option for devastated anatomy, though some patients are notably frail. We sought to elucidate the risks of urinary diversion in patients with a history of radiation for gynecologic malignancy. METHODS: A retrospective review was performed of patient records during the period of 2008 - 2018 from three tertiary centers. Women were identified who underwent continent or incontinent urinary diversion for urinary adverse effects of gynecologic radiotherapy. Indications for diversion included: radiation cystitis, fistula, incontinence, perineal wounds, and urinary tract stricture disease. Sarcopenia was determined by Slice-o-matic software (Tomovision, Quebec, CA) by skeletal muscle index (SMI) based on preoperative CT when available. Outcomes include any post-operative complication within 90 days of surgery as well as 30-day readmission rate. Long-term outcomes, including ureteral stenosis, stomal complications, fistula, renal dysfunction, and bowel function, were also examined. RESULTS: A total of 34 patients from three institutions were included for analysis. The majority were white/Caucasian (73.5%). Median body mass index (BMI) was 24 kg/m2 (interquartile range [IQR] 19.4 - 30). 26/34 (76.5%) underwent non-continent diversion. Median estimated blood loss (EBL) was 300 (IQR 150 - 500). 25/34 (73.5%) of women experienced complications within 90 days; 9/34 (26.5%) experienced high grade (Clavien grade 3 and above) complications. 11/34 (32.4%) of women were readmitted within 30 days. Patients who experienced high grade complications had more sarcopenia (SMI 38.1 vs. 45.7, p=0.047) compared to those who did not. CONCLUSIONS: Urinary diversion for late adverse effects of gynecologic radiotherapy is fraught with complications. Patients experiencing high grade complications had lower skeletal muscle index. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, especially in the setting of a frail patient. Source of Funding: None