Urinary Tract Changes with Benign Pelvic Tumors

Abstract

Listen

Translate article

Although the physiological alterations in the urinary tract which occur during pregnancy are well known to radiologists and clinicians, the secondary changes produced by pressure of benign pelvic tumors are not so widely recognized. Many benign pelvic tumors in women are capable of causing changes in the upper urinary tract. The recognition of the frequent occurrence of these alterations is important both to the pelvic surgeon and to the student of the ureter in pregnancy. In 1935, Baker and Lewis (1) compared the alterations of the urinary tract occurring in pregnancy with those produced by pelvic tumors. Their series included 16 patients with pelvic tumors comparable in size to the pregnant uterus after the third month of gestation. In these patients the quantitative and qualitative alterations in the upper urinary tract were similar to those of pregnancy; a high degree of dilatation was observed in pregnancy, in large ovarian cysts, and in fibromyomas of the uterus. The changes were attributed largely to mechanical pressure. Kretschmer and Kanter (3) found a high incidence of urinary changes in 51 female patients with benign pelvic tumors. By urography, they showed that 65.7 per cent of myomas and 81.9 per cent of ovarian cysts produced significant alterations in the upper urinary tract. The higher incidence of changes associated with ovarian cysts was explained on the basis of the soft consistency of the tumor and its ability to mold or compress the ureters at the brim of the true pelvis. Since 1937, we have studied, by excretory urography, 96 adult female patients with benign pelvic tumors of various sizes. Several months after the tumor was removed, another urographic study was done.2 There were no clinical signs or symptoms of significant urinary tract disease in any of these patients. Thirty cubic centimeters of diodrast3 were injected intravenously, and a minimum of four radiographic exposures made. These included a roentgenogram of the abdomen, one in the supine position five minutes after the injection, another in the Trendelenburg position at fifteen minutes, and one in the erect posture at twenty minutes. Of the 96 patients in our series, 66 (68.7 per cent) showed roentgen evidence of ureteral obstruction, displacement, or both. Obstruction occurred in 46 (47.9 per cent), displacement in 12 (12.5 per cent), and both obstruction and displacement were present in 8 (8.7 per cent). Myomas of the uterus were encountered in 77 patients; 14 patients had ovarian cysts, and 5 had both a myoma and a cyst. Abnormal urographic changes were observed in 56 patients (72.5 per cent) with myomata, 6 (43 per cent) with ovarian cysts, and 4 (80 per cent) with both cyst and myoma (Table I). A correlation of the size of the tumor as found at operation and the incidence of abnormal effects in the urinary tract is presented in Table II. Fifty of the pelvic tumors were approximately 10 cm. in diameter, and 2 measured as much as 30 cm.