Surgery for urologic complications following radiotherapy for gynecologic cancer

Urologic surgery was necessitated by complications following radiotherapy for gynecologic cancer in 17 patients. Four had recurrent malignant disease and 13 were without evidence of malignancy. The median interval to onset of the urologic complications was 18 (range 0-144) months. Ileal substitution was performed because of bilateral ureteral obstruction in two cases, and transureteroureterostomy for unilateral obstruction in one case. Vesicovaginal fistula was present in 14 patients, who underwent urinary diversion--cutaneous ureterostomy and ligation of the other ureter (6 cases), cutaneous ureterostomy and transureteroureterostomy (3) and ileal conduit diversion (5). The immediate morbidity and mortality were determined by the patients' general state of health rather than by presence or absence of recurrent malignant disease. The choice of diversion procedure should be guided by the patient's fitness, the status regarding recurrence of malignancy and the distribution of function between the two kidneys.