Manifestation, Latency and Management of Late Urological Complications after Curative Radiotherapy for Cervical Carcinoma

Abstract

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.

Extensive Necrosis of the Bladder with Hypostatic Abscess: A Late Complication after Radiotherapy

“…Severe complications like ureteral stenosis, fistula formation and bladder rupture are rare and, above all, can have a notoriously long latency period [3]. These complications are challenging to treat because of radiogenic tissue damage [2].…”

Continent Urinary Diversion in Patients with Pelvic Irradiation: An Alternative Utilizing Transverse Colon Reservoir

“…Several techniques have been described to treat these patients. The use of irradiated segments may present an unnecessary risk of complications due to radiation therapy as well as the use of irradiated bladder [1][2][3]. Transverse colon is not located in the radiation field [4].…”

“…The risk of utilizing previously irradiated bowel segments is well known and should be avoided [1,2,3]. The use of transverse colon is a safe and effective alternative [4,5].…”

Cervical necrosis after chemoradiation for cervical cancer: case series and literature review

“…Mild and acute side effects are experienced by most patients, and are generally transitory [1-3]. Severe long-term toxicity, accounting for 1% to 3% [4], is well documented [5,6], and involves gastrointestinal and urological systems: distal ureteral necrosis, distal ureteral stenosis, vesico-vaginal fistula, vesico-intestinal fistula, severe fibrotic bladder shrinkage, urethral stenosis, and bladder necrosis [7,8]. …”