Background: Radiotherapy alone or in combination with radical hysterectomy remains a potentially curative treatment for cervical carcinoma. Late urological complications after curative radiotreatment are rare but often present difficult problems of management due to the progressive nature of radiogenic tissue damage. We reviewed all cases of radiogenic urologic complications after radiotherapy for cervical carcinoma treated at our institution over the past 10 years. Patients and Methods: In a retrospective analysis, out of all female patients treated for hydronephrosis (n = 543), 93 patients with hydronephrosis occurring after curative treatment for gynecological malignancies were identified. The most frequent cause was progressive disease (n = 55); 30 patients without recurrence had severe radiogenic urological complications (study population). Results: Out of 30 patients with a mean age of 44.9 years at the time of treatment for cervical cancer, 6 had undergone primary radiotherapy and 24 had received adjuvant radiotreatment after radical hysterectomy. The observed late urological complications were: distal ureteral stenoses (bilateral in 4 cases, unilateral in 15 cases), distal ureteral necrosis (n = 1), bilateral ureteral reflux (n = 3), vesico-vaginal fistulae (n = 5), vesico-intestinal fistula (n = 1), severe fibrotic bladder shrinkage (n = 6) and urethral stenosis (n = 2). Marked signs of radiogenic cystitis were observed in almost all patients. The mean latency time between radiotherapy and manifestation of severe radiogenic urological sequelae was 19.4 years (range 0.5–41.5). Primary treatment of urological complications consisted in temporary urinary diversion by percutaneous nephrostomies or insertion of internal ureteral stents. Permanent treatment for radiogenic ureteral stenosis in all patients with sufficient general health consisted of surgical or endourological urinary diversion or reconstruction. However, the majority of patients were managed by permanent endourological measures. Lower tract fistulae were treated by distal ureteral occlusion and diversion. Conclusions: Although severe late urological sequelae of curative radiotherapy for cercvical carcinoma are rare they represent major complications, result in considerable distress for the patient, and often present difficult therapeutic problems for the urologist. As these urological complications can have extremely long latency times, focussed follow-up for early detection may be advisable.
Introduction: Primary renal lymphoma (PRL) as a clinical entity is not undisputed because the kidneys do not contain lymphatic tissue and the mechanism of development of PRLs is unclear. Most of the few cases reported showed rapid systemic progression and a poor prognosis. Although there are no clearly defined diagnostic criteria for renal lymphomas, abdominal and thoracic computed tomography as well as renal and bone marrow biopsy are recommended. 3 cases of renal lymphoma are reported and their diagnosis and management discussed. Case Reports: Between 1996 and 2001, 3 male patients with renal lymphoma were diagnosed and treated at our institution. In patient No. 1, because of persisting macroscopic hematuria a bilateral PRL was diagnosed by renal biopsy, without any detectable lesions on CT imaging. Patient No. 2 presented with a large renal mass which, on biopsy, was diagnosed as a lymphoma. Patient No. 3 showed lymphoma on renal biopsy and bone marrow involvement. All 3 patients were treated with systemic chemotherapy which resulted in death of disease in 2 patients and a complete remission in 1 patient after adjuvant radiotherapy and nephrectomy. Conclusion: PRL represents a rare entity which must nevertheless be considered in cases of unusual renal masses or otherwise unexplained renal symptoms. If diagnosed early, cure is possible, and multimodal treatment should be considered.
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