[Ureteral obstruction after radiotherapy in patients with cancer]

Diagnosis and treatment of postradiation ureteral obstruction is a problem of utmost importance, whose resolution will make it possible to prolong survival of many postcancer patients. A review of 58 cases of ureteral compression as a result of radiation and combined treatment for cervical, uterine and vesical cancer is presented. Upper urinary tract changes were shown to range from moderately dilated calycopelvic system to bilateral ureterohydronephrosis and a nonfunctional kidney. The fact that postradiation urethral compression remains asymptomatic for a long period of time makes the diagnosis still more difficult. Mean interval between radiotherapy and the detection of ureteral obstruction was 5.6 years. Ureteral affection was either isolated or combined with vesicovaginal fistulas and radiation cystitis. Short ureteral strictures were detected in 37 (68.9%) patients, and long strictures, in 16 (31.1%), mostly in cases of combined treatment. Urinary infection and pelvic inflammation are major contributing factors to postradiation ureteral obstruction. Surgical treatment was performed in 34 (64.2%) patients with postradiation ureteral stenosis; the operation was limited to nephrectomy of urine collection because of the patient's grave condition in 25 (73.5%) of those.