Untreated cervical cancer complicated by obstructive uropathy and oliguric renal failure

Abstract

Between 1955 and 1980, 18 patients were seen with untreated cervical cancer, bilateral ureteral obstruction, and oliguric renal failure. Medical and surgical management of renal failure were both employed; both methods were useful and neither method seemed clearly superior. Eight patients had medical management of renal failure and pelvic irradiation. Six of these experienced spontaneous resolution of oliguria before radiation therapy was completed. Congestive heart failure from increased intravascular volume was the most frequent complication of medical management. Surgical relief of ureteral obstruction was effective in eight patients. Three had open nephrostomy, three had retrograde ureteral catheterization alone, and two had retrograde catheterization followed by percutaneous nephrostomy. Infection, the most frequent complication of surgical diversion, developed in six patients. Unilateral relief of obstruction was performed in seven patients but was accompanied by postobstructive diuresis in only four patients. Dialysis was selectively employed in patients managed medically and surgically to temporarily control increased intravascular volume or for other complications of renal failure. Thirteen patients completed pelvic irradiation for local control of their malignancy with a mean survival of 16.9 months. The five patients whose renal failure and cervical cancer were not treated survived an average of only 25.6 days. Although none of the patients in this review has survived beyond 34 months, the results of comprehensive management of renal failure and pelvic irradiation justify further pursuit of this approach. Between 1955 and 1980, 18 patients were seen with untreated cervical cancer, bilateral ureteral obstruction, and oliguric renal failure. Medical and surgical management of renal failure were both employed; both methods were useful and neither method seemed clearly superior. Eight patients had medical management of renal failure and pelvic irradiation. Six of these experienced spontaneous resolution of oliguria before radiation therapy was completed. Congestive heart failure from increased intravascular volume was the most frequent complication of medical management. Surgical relief of ureteral obstruction was effective in eight patients. Three had open nephrostomy, three had retrograde ureteral catheterization alone, and two had retrograde catheterization followed by percutaneous nephrostomy. Infection, the most frequent complication of surgical diversion, developed in six patients. Unilateral relief of obstruction was performed in seven patients but was accompanied by postobstructive diuresis in only four patients. Dialysis was selectively employed in patients managed medically and surgically to temporarily control increased intravascular volume or for other complications of renal failure. Thirteen patients completed pelvic irradiation for local control of their malignancy with a mean survival of 16.9 months. The five patients whose renal failure and cervical cancer were not treated survived an average of only 25.6 days. Although none of the patients in this review has survived beyond 34 months, the results of comprehensive management of renal failure and pelvic irradiation justify further pursuit of this approach.