Ureteral assessment after radical hysterectomy

Area of Science:

• Urogynecology
• Oncologic Surgery

Background:

• Cervical cancer management often involves radical hysterectomy and pelvic lymphadenectomy.
• Ureteral injury is a potential complication of these procedures.

Purpose of the Study:

• To evaluate the utility of routine preoperative and postoperative intravenous pyelography in patients with stage IB cervical carcinoma undergoing radical hysterectomy.

Main Methods:

• Retrospective analysis of 233 patients with stage IB cervical carcinoma.
• Review of intravenous pyelography findings and intraoperative/postoperative outcomes.

Main Results:

• Symptomatic ureteral injury occurred in 4 patients (1.7%), including 2 fistulae and 1 stricture.
• No ureteral injuries were found in asymptomatic patients.
• Transient ureteral dilatation occurred in 5.2% of asymptomatic patients.
• Significant urinary tract anomalies were noted in 3.4% of preoperative studies.
• Three intraoperative ureteral transections (1.3%) were repaired without sequelae.

Conclusions:

• Routine intravenous pyelography may not be essential for all patients with early cervical cancer undergoing primary surgical treatment.
• The diagnostic yield for significant ureteral injury appears low in the absence of symptoms.