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Postradiation ureteral obstruction: a reappraisal
American Journal of Obstetrics and Gynecology
|February 1, 1981
Summary
Radiation therapy for cervical cancer can cause hydronephrosis due to periureteral fibrosis. This condition is more common in early-stage disease and appears years after treatment, unlike recurrent tumors which present with leg edema and pain.
Area of Science:
- Urology
- Gynecologic Oncology
- Radiation Oncology
Background:
- Hydronephrosis is a potential complication following radiation therapy for cervical cancer.
- Distinguishing between radiation-induced fibrosis and recurrent malignancy is crucial for patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of hydronephrosis in cervical cancer patients treated with radiation.
- To identify factors associated with obstructive uropathy due to periureteral fibrosis versus recurrent tumor.
Main Methods:
- Retrospective analysis of 34 patients with cervical cancer who developed hydronephrosis post-radiation therapy.
- Evaluation of clinical staging, time to obstruction, and associated symptoms to differentiate causes.
Main Results:
- 35% of hydronephrosis cases were attributed to periureteral fibrosis without recurrent malignancy.
- Obstructive uropathy from fibrosis was more frequent with unilateral lesions, earlier disease stages (IB/II), and delayed onset (≥2 years post-radiation).
- Hydronephrosis with leg edema and sciatic pain suggested recurrent tumor.
Conclusions:
- Periureteral fibrosis is a significant cause of urinary tract obstruction after cervical cancer radiation.
- Clinical presentation, including timing and associated symptoms, aids in differentiating fibrosis from recurrence.
- Laparotomy should be considered when malignancy cannot be excluded by other diagnostic methods.