Urological complications in gynecological surgery and radiotherapy

Urological complications in connection with gynaecologically or obstetrically indicated operations are rare and usually only of clinical importance when they are not recognized and treated during the operation or in the immediate postoperative period. In such cases, for example, a ureteral lesion can result in loss of the function of the ipsilateral kidney, which is particularly serious when the primary operation was carried out for a benign primary disease. The aim of the present study was therefore to demonstrate to the gynaecologist above all the preventive and diagnostic measures serving to prevent lesions to the efferent urinary pathways or to aid their immediate diagnosis. Amongst the preventive measures is included first a discussion of the pelvic anatomy which, in consideration of the special problems involved in the preparation of the caudal ureter in extended abdominal hysterectomy, is supplemented by experimental and clinical studies on vascularization of the ureters. This section also includes a detailed description of the topographic and sometimes functional divergences of the urinary tract from the norm under physiological and pathological conditions, such as are typically encountered in gynaecologico-obstetric patients, since these deviations predispose patients towards urological complications during surgical interventions. The diagnostic measures include above all the dye tests which can be performed without special technical equipment, and radiological examinations. The radiological tests are illustrated by examples selected from some 300 urograms taken over the past 20 years. The data reported in the literature on the lesions to the efferent urinary pathways are supplemented by data from about 4,000 case histories of patients treated at the Zürich University Gynaecological Clinic by surgery or radiotherapy between 1960 and 1980. The possibilities of a synoptic evaluation of the complication rates of such cases reported in the literature, or a comparison with personal experience, are very limited, since not only is the patient material under consideration very heterogeneous, but in many cases there are sometimes very considerable differences in the preventive measures implemented, in the surgical techniques, in the surgical radicality, and--in the case of combined surgery and radiotherapy--in the treatment plans and types of irradiation. The guidelines relating to the treatment of lesions to the efferent urinary pathways caused by surgery or radiotherapy are presented in detail insofar as they are of importance for the gynaecologist as immediate measures.(ABSTRACT TRUNCATED AT 400 WORDS)