# Double-Barrel Uro-Colostomy Versus Ileal Conduit for Urinary Diversion After Pelvic Exenteration: A Systematic Review and Meta-Analysis of Comparative Outcomes

## TL;DR

This study compares two urinary diversion methods after pelvic surgery and finds that a single-stoma approach may be safer and simpler.

## Contribution

The study provides the first meta-analysis comparing outcomes of double-barrel uro-colostomy and ileal conduit after pelvic exenteration.

## Key findings

- Double-barrel uro-colostomy had lower urinary leak rates compared to ileal conduit.
- Both methods had similar overall complication rates and fistula occurrences.
- The single-stoma approach may offer patient-centered benefits and is a feasible alternative.

## Abstract

Pelvic exenteration is a major operation used to treat advanced cancers in the pelvis. After this surgery, patients need new pathways for both urine and stool to leave the body. The traditional method uses two separate stomas—one for urine and one for stool—while a newer method, called double-barrel uro-colostomy, combines both into a single stoma. This study reviewed and combined results from previous research comparing these two techniques. We found that the single-stoma approach had fewer urine leaks and similar overall complication rates. This suggests it may be a safe and simpler alternative for selected patients. These findings may help guide surgeons in choosing the most suitable reconstruction method and encourage further research into long-term outcomes and quality of life.

Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20, p = 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37, p = 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21, p = 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed.