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%.

Hysterectomy and kidney cancer risk: A meta‐analysis

“…both hormonal and iatrogenic factors are suggested. [5][6][7][8][9][10][11][12] Fluctuating sex hormones have been shown to make nephrons vulnerable to inflammation and oxidative stress. 6,7 Hormone replacement therapy, common among women who underwent a hysterectomy, may adversely affect the kidneys as progesterone has been shown to inhibit the kidney's ability to filter out toxins and estrogen-mediated cell proliferation in animals has been observed as an early event in the progression of estrogen carcinogenesis.…”

“…31,32 Anatomic changes after surgery has been suspected to lead to renal damage through increased lipid per-oxidation, hydronephorsis and renal obstruction. 5,[8][9][10][11][12] Inadvertent injury to the ureter during surgery has been shown to lead to an increased incidence of post renal obstruction. 33 Persistent hydronephrosis without evidence of injury to the ureter, but possibly due to secondary pelvic anatomy changes post surgery, has also been reported in several prospective studies.…”

“…5 We found evidence suggesting that women who underwent hysterectomy have a 32% increased relative risk of future kidney cancer, possibly as a result of hormonal and/or iatrogenic effects. [5][6][7][8][9][10][11][12] Findings from previous epidemiologic studies have been inconsistent, [13][14][15][16][17][18][19][20][21][22][23][24][25][26] with the majority of investigations having insufficient statistical power to detect an association of this magnitude. We conducted a systematic review and meta-analysis to summarize and better understand the published epidemiologic evidence regarding hysterectomy and kidney cancer risk.…”

Urological complications of okabayashi's operation for cervical cancer

“…Since 1939 the radical hysterectomy has been supplemented by consistent removal of the pelvic lymph nodes as performed by Meigs (8). The Wertheim-Meigs operation is more radical (1, 4, 5, 11, 13,14) but there is a significant number of serious urological complications (7,9,15,16). In recent decades a modified technique for radical hysterectomy, originally described by Okabayashi in 1921, has been used in different centers in an attempt to reduce the number and severity of urological complications (12).…”

Abnormal Ureteral Peristaltic Activity During Pregnancy

“…The transport of urine from the renal pelvis to the urinary bladder is due mainly to ureteral peristalsis, a phenomenon which is of great interest to the gynaecologist. It is well known that pregnancy as well as tumours of the reproductive organs can interfere with the transport of urine by compressing the ureter ( 3 , 4 , 7,9,10,14,15). However, ureteral dilatation characteristic of pregnancy may also be due to the effect of progesterone and the effect on flow may not be due solely to extrinsic pressure (3,8).…”