The wallace technique of ureteroileal anastomosis and its use in gynecologic oncology: A study of 81 cases

Objective: To report the indications for surgery, morbidity, and results of treatment using the Wallace ileal conduit for supravesical urinary diversion. Methods: Over a 15-year period (1977-1991), 81 patients, all with an underlying gynecologic malignancy requiring urinary diversion, had ileal conduit surgery performed at the Regional Department of Gynecological Oncology, Gateshead, England using the Wallace technique. Patient details stored in a computerized data base were reviewed retrospectively. Results: Thirty-nine patients (48%) had received radiotherapy before conduit surgery. In 70% of cases, urinary diversion was performed as part of an exenterative procedure. Early postoperative complications occurred in 56% of cases and were mainly related to infection. Long-term complications included fistula (three), stoma retraction (three), loss of renal function (three), tumor metastases (two), and stoma herniation (one). There was one postoperative death secondary to septicemia. By 1991, 42 patients (52%) had died of their primary disease. Conclusion: We believe that for urinary diversion in the gynecologic oncology patient, the ileal conduit, in particular the Wallace technique, is the procedure of choice.