Urinary procedures in gynecologic oncology: a comprehensive literature review and management algorithm proposal.

Abstract

Objectives: Urological involvement is common in gynecologic oncology because of the close anatomical relationship between the urinary and reproductive systems. However, comprehensive data on the indications and outcomes of urological procedures in this setting remain limited. This review provides a structured overview of urological reconstructive techniques in gynecologic oncology and proposes a practical management algorithm based on current evidence and institutional experience. A literature review was conducted using PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Eligible sources included peer-reviewed original articles, systematic and narrative reviews, meta-analyses, and guidelines or expert-consensus documents. Case reports, preprints, and non-English publications were excluded.

Findings: Urological procedures are required in approximately 11% of gynecologic oncology surgeries, most frequently in cases of cervical cancer. Reconstructive strategies depend on the location and extent of urinary tract involvement. Distal ureteral defects are commonly managed with ureteroneocystostomy, with or without a psoas hitch or Boari flap. For extensive ureteral loss, Yang-Monti ileal ureter replacement offers favorable long-term outcomes with reduced morbidity compared to traditional ileal interposition. Partial bladder resection can often be managed with primary closure when adequate bladder capacity is preserved, whereas augmentation cystoplasty or urinary diversion is required in more extensive cases. Following total cystectomy, both continent (eg, Miami pouch and orthotopic neobladder) and non-continent (eg, Bricker ileal conduit and ureterostomy) diversions are viable options, with complication rates largely influenced by patient selection and surgical complexity.

Summary: A wide range of urological reconstructive techniques are available in gynecologic oncology. Surgical decision-making should be individualized and based on anatomical, oncological, and patient-related factors. Multidisciplinary expertise is essential to optimize functional outcomes and minimize complications.