[Ureter and Wertheim's operation]

The surgery for carcinoma of the uterine cervix combined with radiotherapy, as carried out at present, includes a definite risk for the urinary tract. Not so much the immediate functional disorders, which always recede, except in rare cases of fibrous retracted bladder, but the lesions which occur in several varieties lead one to re-implant immediately the ureter. Fistulae and early stenosis (16 out of 1,500) should be treated in the same way. These late complications, such as obstruction (12 out of 1,500) raise de problem of their etiology. Usually they are due to recurrent carcinoma (9 out of 12), rarely due to pelvic fibrosis (3 out of 12). It is rare then for re-implantation to be possible. There remains either nephrectomy which is the simplest solution, or an urinary by-pass operation either using an ileal bladder or as a palliative measure, using a silastic prosthesis. Finally, the risk of advanced carconoma is without remedy, abstention from surgery may then be justified but one should, as far as possible, attempt to prevent these complications both from the surgical technical point of view and from the point of view of irradiation dosage.