Ureteric complications following treatment of gynaecological cancer

The incidence, development and diagnosis of ureteric injuries secondary to radical operative or radiological treatment of uterine malignancy is described. Special attention is paid to the importance of early detection and management. Immediate peroperative repair of surgical ureteric damage gives most favourable results. Also in postoperatively diagnosed ureteric lesions the definitive treatment has to be carried out without delay. Ureteroneocystostomy, psoas-hitch procedure or transureteroureterostomy are the most preferable methods. In the late ureteric strictures secondary to radiotherapy the operation techniques employing nonirradiated tissues are recommended, eg. transureteroureterostomy, ileal replacement of strictured ureter and ileo-uretero-cystostomy or ileo-uretero-cutaneostomy. An ureteric prosthesis or ureteric stent may also be used in special cases. Ureteric complications following operative or radiological treatment of pelvic malignancy are usually curable. Therefore the employment of isotope renography or intravenous pyelography regularly is essential in the follow-up of asymptomatic patients and always immediately at the appearance of any urinary tract complaint in patients previously treated for pelvic malignancy.