Outcomes of Urinary Diversion for Late Adverse Effects of Gynecologic Radiotherapy

Objectives To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs. non-continent) or concomitant cystectomy (vs. bladder-sparing diversion). Methods : A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008 - 2018 from three tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade post-operative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. Results : Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). 26/34 (76.5%) underwent non-continent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9/34 (26.5%) experienced high-grade (Clavien grade ≥3) complications. Thirty two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (p=0.49), concurrent cystectomy (p=0.70), or sarcopenia (p=1.0). Conclusions : Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant pre-operative markers which may pre-dispose patients to significant complications.