Continent ileocolonic urinary reservoir (Miami pouch): The University of Miami experience over 15 years

Emery M. Salom, Luis E. Mendez, Dana Schey, Nicholas Lambrou, Noor Kassira, Orlando W Gomez-Marin, Hervy Averette, Manuel Peñalver, Peter Schwartz

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: A patient with a recurrent central pelvic malignancy after radiation will require urinary diversion as part of the reconstructive phase of the pelvic exenteration. The aim of our study was to assess the result of our 15-year experience with a continent ileocolonic urinary reservoir, which is known as the Miami pouch. Study design: Since 1988, all patients who received a continent ileocolonic urinary reservoir in the Division of Gynecologic Oncology, University of Miami School of Medicine, were included in the study. Parameters that were evaluated during the study period include functional outcomes, early and late perioperative complications, and their treatment. Results: A total of 90 patients were identified from February 1988 to December 2002. Seventy-eight patients (87%) had a recurrent central pelvic malignancy, and 82 patients (91%) received radiation before the Miami pouch procedure. The non-reservoir-related morbidities were fever (76%), wound complication (30%), pelvic collection (12%), ileus/small bowel obstruction (12%), and postoperative death (11%). The most common reservoir-related complications were urinary infection (40%), ureteral stricture (20%), and difficulty with self-catheterization (18%). In our study, the overall complication rate that was related directly to the Miami pouch was 53%. Conservative treatment resolved > 80% of these cases. The rate of urinary continence that was achieved in our patients was 93% during our 15-year experience with the Miami pouch. Conclusion: The Miami pouch is a good alternative for continent urinary diversion during exenteration or radiation-induced damage. The rate of major complications that require aggressive surgical intervention is acceptable. Most postoperative complications (80%) can be corrected with the use of conservative techniques that are associated with fewer deaths than reoperation and thus should be used first. The technique is simple and effective in women who are at high risk, who have undergone previous radiation therapy, and who have a high rate of functional success and is a profound advantage for a woman's psychosocial well-being.

Original languageEnglish
Pages (from-to)994-1003
Number of pages10
JournalAmerican Journal of Obstetrics and Gynecology
Volume190
Issue number4
DOIs
StatePublished - Apr 1 2004

Fingerprint

Continent Urinary Reservoirs
Urinary Diversion
Radiation
Pelvic Exenteration
Ileus
Reoperation
Catheterization
Neoplasms
Pathologic Constriction
Fever
Radiotherapy
Medicine
Morbidity
Wounds and Injuries
Infection

Keywords

  • Continent ileocolonic urinary reservoir
  • Miami pouch
  • Pelvic exenteration
  • Reconstruction
  • Urinary diversion

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Salom, E. M., Mendez, L. E., Schey, D., Lambrou, N., Kassira, N., Gomez-Marin, O. W., ... Schwartz, P. (2004). Continent ileocolonic urinary reservoir (Miami pouch): The University of Miami experience over 15 years. American Journal of Obstetrics and Gynecology, 190(4), 994-1003. https://doi.org/10.1016/j.ajog.2004.01.023

Continent ileocolonic urinary reservoir (Miami pouch) : The University of Miami experience over 15 years. / Salom, Emery M.; Mendez, Luis E.; Schey, Dana; Lambrou, Nicholas; Kassira, Noor; Gomez-Marin, Orlando W; Averette, Hervy; Peñalver, Manuel; Schwartz, Peter.

In: American Journal of Obstetrics and Gynecology, Vol. 190, No. 4, 01.04.2004, p. 994-1003.

Research output: Contribution to journalArticle

Salom, EM, Mendez, LE, Schey, D, Lambrou, N, Kassira, N, Gomez-Marin, OW, Averette, H, Peñalver, M & Schwartz, P 2004, 'Continent ileocolonic urinary reservoir (Miami pouch): The University of Miami experience over 15 years', American Journal of Obstetrics and Gynecology, vol. 190, no. 4, pp. 994-1003. https://doi.org/10.1016/j.ajog.2004.01.023
Salom, Emery M. ; Mendez, Luis E. ; Schey, Dana ; Lambrou, Nicholas ; Kassira, Noor ; Gomez-Marin, Orlando W ; Averette, Hervy ; Peñalver, Manuel ; Schwartz, Peter. / Continent ileocolonic urinary reservoir (Miami pouch) : The University of Miami experience over 15 years. In: American Journal of Obstetrics and Gynecology. 2004 ; Vol. 190, No. 4. pp. 994-1003.
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abstract = "Objective: A patient with a recurrent central pelvic malignancy after radiation will require urinary diversion as part of the reconstructive phase of the pelvic exenteration. The aim of our study was to assess the result of our 15-year experience with a continent ileocolonic urinary reservoir, which is known as the Miami pouch. Study design: Since 1988, all patients who received a continent ileocolonic urinary reservoir in the Division of Gynecologic Oncology, University of Miami School of Medicine, were included in the study. Parameters that were evaluated during the study period include functional outcomes, early and late perioperative complications, and their treatment. Results: A total of 90 patients were identified from February 1988 to December 2002. Seventy-eight patients (87{\%}) had a recurrent central pelvic malignancy, and 82 patients (91{\%}) received radiation before the Miami pouch procedure. The non-reservoir-related morbidities were fever (76{\%}), wound complication (30{\%}), pelvic collection (12{\%}), ileus/small bowel obstruction (12{\%}), and postoperative death (11{\%}). The most common reservoir-related complications were urinary infection (40{\%}), ureteral stricture (20{\%}), and difficulty with self-catheterization (18{\%}). In our study, the overall complication rate that was related directly to the Miami pouch was 53{\%}. Conservative treatment resolved > 80{\%} of these cases. The rate of urinary continence that was achieved in our patients was 93{\%} during our 15-year experience with the Miami pouch. Conclusion: The Miami pouch is a good alternative for continent urinary diversion during exenteration or radiation-induced damage. The rate of major complications that require aggressive surgical intervention is acceptable. Most postoperative complications (80{\%}) can be corrected with the use of conservative techniques that are associated with fewer deaths than reoperation and thus should be used first. The technique is simple and effective in women who are at high risk, who have undergone previous radiation therapy, and who have a high rate of functional success and is a profound advantage for a woman's psychosocial well-being.",
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