Obstruction of the upper urinary tract after treatment of carcinoma of the uterine cervix.

Abstract

The frequency of obstruction of the upper urinary tract after treatment of carcinoma of the uterine cervix was assessed in an investigation of 100 consecutive patients. 64 of the women were treated surgically (Wertheim hysterectomy); the remaining 36, with Wertheim hysterectomy combined with radiotherapy (combined treatment). The patients were examined with isotope renography and with i.v. urography before, as well as 14 dyas, 2 months, 4-6 months, and 1, 2, 3, 4 and 5 years after, the operation. When necessary, these examinations were supplemented by retrograde pyelography, intravenous pyelography and selective renal function tests. Postoperatively 40.3% of the patients treated with surgery alone showed signs of ureteric obstruction whereas the figure for those treated with the combined treatment was 55%. Of the patients 25 developed in the early postoperative course mild ureteric obstruction which disappeared within half a year. Such mild obstruction was not regarded as a true complication of the treatment given. On the other hand, 21 patients developed obstinate ureteric obstruction. In 14 of these patients surgical intervention was necessary to save renal function. Most of the patients with serious ureteric obstruction had fairly advanced carcinoma (15 of stage 2 and 6 of stage1). Radiotherapy had been given more often in this group (15 out of 21) than in the rest. In 4 of the patients the ureteric obstruction was due to a recurrence of a tumour. This means that the true frequency of postoperative ureteric obstruction was 17%. In the group given combined treatement urinary stasis persisted longer than in the group treated with surgery alone. Renography and urography were done on 682 occasions and the results did not agree in 14%.