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Sarwar A, Eminowicz G. Radiotherapy induced ureteric stenosis in locally advanced cervical cancer: A review of current evidence. Brachytherapy 2024; 23:387-396. [PMID: 38643044 DOI: 10.1016/j.brachy.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Concurrent chemo-radiation followed by high dose rate brachytherapy is the standard of care for locally advanced cervical cancer. The proximity of the ureters to the tumor volume risks ureteric stenosis. Here we outline the current understanding of radiotherapy induced ureteric stenosis in patients treated for cervical cancer, focusing on the incidence, risk factors, clinical consequences, and management. METHODS Searches on EMBASE, PubMed, Science Direct, and Google Scholar were performed for publications reporting on radiotherapy, cervix cancer and ureteric stenosis. Multi and single center, prospective/retrospective, cohort, and cross-sectional studies were included. RESULTS This narrative review identified key issues relevant to radiation induced ureteric stenosis in cervical cancer in the literature. Thirteen studies were evaluated, identifying crude and actuarial rates of ureteric stenosis of 0.3-13.5% and 1.5-4.4% (at 5 years) respectively. The risk of ureteric stenosis is highest in the first 5 years after radiotherapy but continues to occur at a rate of 0.15% per year. Risk factors including advanced FIGO stage, tumor size >5 cm and baseline hydronephrosis increase the incidence of ureteric stenosis. EQD2 doses of ≥ 77Gy were significantly associated with ≥grade 3 ureteric morbidity. The majority of patients were managed with nephrostomy +/- ureteric stent insertion, with some requiring ureteral reimplantation, urinary diversion or nephrectomy. CONCLUSIONS This review has identified multiple considerations, highlighting the need to identify patients highest at risk of ureteric stenosis. There is also a need to recognize ureters as organs at risk, record dose exposure, and apply dose constraints, all of which set the landscape for allowing dose optimization.
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Affiliation(s)
- Asma Sarwar
- University College London Hospitals, London, UK; University College London, London, UK.
| | - Gemma Eminowicz
- University College London Hospitals, London, UK; University College London, London, UK
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2
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Dabbagh M, Maazouz A, Moujahid M, Bounaim A, Bouchentouf SM. Generalized Peritonitis Secondary to Spontaneous Rupture of the Urinary Bladder. Cureus 2024; 16:e60053. [PMID: 38854308 PMCID: PMC11162757 DOI: 10.7759/cureus.60053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
A spontaneous rupture of the urinary bladder (SRUB) is an exceedingly rare surgical emergency that might be misdiagnosed, resulting in a high mortality risk. Clinicians should be mindful that secondary peritonitis can occur as a result of a ruptured urinary bladder, which is frequently misdiagnosed and undertreated. The majority of cases are identified during laparotomy. We report a case of a 70-year-old woman who had irradiation for endometrial cancer 25 years ago and had a history of hypertension, diabetes, and recurring urinary tract infections. The current study sought to determine the etiology of SRUB as well as clinical aspects and diagnostic strategies. She was diagnosed with generalized peritonitis. An exploratory laparotomy discovered a perforated urinary bladder. Following further care, the patient was released with no further complaints.
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Affiliation(s)
- Mahmoud Dabbagh
- Department of Surgery, Mohammed V Military Training Hospital, Rabat, MAR
| | - Amine Maazouz
- Department of Surgery, Mohammed V Military Training Hospital, Rabat, MAR
| | | | - Ahmed Bounaim
- Department of Surgery, Mohammed V Military Training Hospital, Rabat, MAR
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Kunichika H, Takahama J, Taguchi H, Haga M, Shimoda E, Inoue M, Morimoto K, Marugami N, Tanaka T. The diagnostic challenge of non-traumatic bladder rupture: a pictorial essay. Jpn J Radiol 2023:10.1007/s11604-023-01395-1. [PMID: 36729190 DOI: 10.1007/s11604-023-01395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
Non-traumatic bladder rupture (NTBR) is relative rare pathology including spontaneous rupture and iatrogenic injury. As increasing the medical intervention for the pelvic malignancy or elderly population, NTBR will be encountered more frequently. There are few previous studies summarizing the imaging features of NTBR. We reviewed imaging characteristics of 18 previous cases of NTBR experienced. In addition, 3 presentative cases that can be a pitfall to differentiate from NTBR. The aim of this article is to clarify the key CT findings of NTBR and its pitfalls.
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Affiliation(s)
- Hideki Kunichika
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-cho, Kashihara, , Nara, 634-8522, Japan.
| | - Junko Takahama
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Hidehiko Taguchi
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Masayo Haga
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Emiko Shimoda
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Masayoshi Inoue
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Kengo Morimoto
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Nagaaki Marugami
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-cho, Kashihara, , Nara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-cho, Kashihara, , Nara, 634-8522, Japan
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4
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Ureter dose optimization during image guided brachytherapy for cervical cancer. Brachytherapy 2022; 21:397-404. [DOI: 10.1016/j.brachy.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022]
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5
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Inoguchi K, Hongo T, Naito H, Nakao A. A Rare Case of Pelvic Abscess Due to Spontaneous Non-traumatic Bladder Rupture. Cureus 2021; 13:e18913. [PMID: 34812299 PMCID: PMC8604095 DOI: 10.7759/cureus.18913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/05/2022] Open
Abstract
Spontaneous bladder rupture is an uncommon and life-threatening urological emergency, and early diagnosis is often challenging. Herein, we report a case of intraperitoneal bladder rupture in an 81-year-old male with neurogenic bladder-the case of intraperitoneal bladder rupture required late laparotomy for pelvic abscess following initial conservative treatment. An eighty-one-year-old male presented to our emergency department with deterioration of consciousness, fever, and hematuria. He denied previous trauma history and had been treated for neurogenic bladder. Physical examination revealed signs of tenderness in the abdomen. A diagnosis of bladder rupture was made based on laboratory examination indicating renal failure and radiological imaging showing urinary ascites. Conservative management with a Foley catheter and antibiotics (meropenem administered 1 g/day) was initiated. On day seven after admission, the patient complained of abdominal pain and fever, and a diagnosis of pelvic abscess based on contrast-enhanced computed tomography and septic peritonitis was made. An emergency exploratory laparotomy for peritoneal drainage was performed. The postoperative course was uneventful, and the patient was discharged on day 29 after admission. Urinary bladder rupture should always be considered as a differential diagnosis in patients presenting with free fluid in the abdomen, peritonitis, reduced urine output, and hematuria. Clinicians should be aware that secondary bacterial peritonitis can occur as a major complication of a ruptured urinary bladder.
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Affiliation(s)
- Kyosuke Inoguchi
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN
| | - Takashi Hongo
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN.,Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hiromichi Naito
- Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Atsunori Nakao
- Emergency, Critical Care and Disaster, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JPN
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6
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Zhang Y, Yuan S, Alshayyah RWA, Liu W, Yu Y, Shen C, Lv H, Wen L, He Y, Yang B. Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature. Front Surg 2021; 8:721705. [PMID: 34796196 PMCID: PMC8592997 DOI: 10.3389/fsurg.2021.721705] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB. Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords "spontaneous bladder rupture" or "spontaneous rupture of bladder" or "spontaneous rupture of urinary bladder." All statistical analyses were conducted using SPSS 20.0 software. Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment. Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.
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Affiliation(s)
- Yue Zhang
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Shuo Yuan
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Rami W A Alshayyah
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Wankai Liu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yang Yu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Chen Shen
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hang Lv
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Lijie Wen
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yi He
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Bo Yang
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China
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7
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Watanabe Y, Yamazaki S, Yokoyama H, Yakubo S, Osaki A, Takaku K, Sato M, Waguri N, Terai S. A Rare Case of Recurrent Generalized Peritonitis Caused by Spontaneous Urinary Bladder Rupture after Radiotherapy: A Case Report and Literature Review. MEDICINES 2021; 8:medicines8110067. [PMID: 34822364 PMCID: PMC8617802 DOI: 10.3390/medicines8110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Since generalized peritonitis is a fatal disease, accurate diagnosis and treatment are important. In this paper, we report a case of recurrent generalized peritonitis associated with spontaneous urinary bladder rupture (SBR). A 65 year old woman, who underwent radiotherapy 21 years prior, was diagnosed with generalized peritonitis. Although the cause of the generalized peritonitis could not be identified, the patient recovered with conservative treatment in short period. However, recurrent episodes of generalized peritonitis occurred four times. We diagnosed the patient with urinary ascites due to SBR, based on a history of radiotherapy and dysuria. No recurrence of generalized peritonitis had occurred after accurate diagnosis and treatment with long-term bladder catheter placement. Since SBR often occurs as a late complication after radiotherapy, it is difficult to diagnose SBR, which leads to delayed treatment. This case and literature review of similar cases suggest that the information of the following might be helpful in the diagnosis of SBR: (i) history of recurrent generalized peritonitis, (ii) pseudo-renal failure, (iii) history of radiotherapy, (iv) dysuria, and (v) increase or decrease of ascites in a short period. It is important to list SBR in the differential diagnosis by knowing the disease and understanding its clinical features. This case and literature review will serve as a reference for future practices.
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Affiliation(s)
- Yusuke Watanabe
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
- Division of Preemptive Medicine for Digestive Disease and Healthy Active Life, School of Medicine, Niigata University, Niigata 951-8510, Japan
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan;
- Correspondence: ; Tel.: +81-25-227-2207; Fax: +81-25-227-0776
| | - Shun Yamazaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan;
| | - Hanako Yokoyama
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan;
| | - Shunta Yakubo
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan;
| | - Akihiko Osaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
| | - Kenichi Takaku
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
| | - Munehiro Sato
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
| | - Nobuo Waguri
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1141, Japan; (S.Y.); (H.Y.); (S.Y.); (A.O.); (K.T.); (M.S.); (N.W.)
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan;
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8
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Lee H, Rojas A, Gachabayov M, Latifi R, Bergamaschi R. Delayed urinary bladder perforation in a hostile post-radiation pelvis. Acta Chir Belg 2021; 121:152-153. [PMID: 33496199 DOI: 10.1080/00015458.2020.1871288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The radiation-induced injury to normal tissue is a well-described phenomenon that incites tissue hypoxia, vascular damage, and parenchymal cell death. In addition to the morbidity caused by the radiation-induced injury itself, surgical management adds to the overall morbidity in these patients. We herein present a case demonstrating challenges of surgical management of urological complications in a radiated pelvis including delayed bladder perforation, recurrence of vesicovaginal fistula, and ureteral stricture. Nonoperative management strategies should be exhausted prior to surgical intervention.
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Affiliation(s)
- Hanjoo Lee
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Aram Rojas
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Mahir Gachabayov
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Roberto Bergamaschi
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Dohm A, Sanchez J, Stotsky-Himelfarb E, Willingham FF, Hoffe S. Strategies to Minimize Late Effects From Pelvic Radiotherapy. Am Soc Clin Oncol Educ Book 2021; 41:158-168. [PMID: 34010045 DOI: 10.1200/edbk_320999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the past 30 years, radiation treatment techniques have significantly improved, from conventional external-beam radiation therapy, to three-dimensional conformal radiation therapy, to current intensity-modulated radiation therapy, benefiting patients who undergo treatment of pelvic malignancies. Modern treatment options also include proton beam irradiation as well as low and high dose rate brachytherapy. Although the acute adverse effects of these modalities are well documented in clinical trials, less well known are the true incidence and optimal management of those late adverse effects that can occur months to years later. In a population of survivors of cancer that is steadily increasing, with many such patients receiving radiotherapy at some time during their disease course, these late effects can become a considerable management and quality-of-life issue. This review will examine the range of late toxicities that can occur from pelvic radiotherapy and explore strategies to prevent and mitigate them.
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10
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Sahin T, Oner U, Baser O, Kurtuncu I. Spontaneous bladder rupture secondary to warfarin overdose: a case report. BMC Emerg Med 2019; 19:80. [PMID: 31849327 PMCID: PMC6918636 DOI: 10.1186/s12873-019-0294-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Warfarin, a vitamin K antagonist, is a widely used medication for the treatment and prophylaxis of thromboembolic events. Patients with various clinical conditions due to warfarin overdose present to emergency departments. Although there may be serious bleeding due to a warfarin overdose, no bleeding may also be seen in some clinical conditions. Some of these bleedings may be life-threatening and result in death. Warfarin overdose and related cases of spontaneous bladder rupture are not frequently observed in the literature. We present a case of spontaneous bladder rupture due to warfarin overdose that was unexpectedly seen in a patient using warfarin for coronary artery disease and arrhythmia. CASE PRESENTATION A 77-year-old Caucasian male patient was admitted to the emergency department with abdominal pain, haematuria, and a reduced volume of urine lasting for three days. The patient's amount of urine was reduced, and he came to the hospital for the first time with this complaint. The patient had local bruises on his arms and legs. From the ultrasound, retrograde cystography and computed tomography images, it was thought that there was blood accumulation due to bladder rupture to the intraperitoneal region. Spontaneous bladder rupture secondary to warfarin overdose was considered for this patient who also had an international normalized ratio (INR) level of 13.4. After the INR level was normalized with vitamin K and a prothrombin complex concentrate, the patient underwent surgery. During the operation, a catheter was placed in the bladder, and the bladder mucosa and muscle were closed separately with a primary repair performed by a urologist. The patient was discharged on the 8th postoperative day without any complications. CONCLUSION In addition to the known findings of warfarin overdose in these patients presenting to the emergency department, we think that the emergency department staff should suspect bladder rupture, which is a fatal complication in the presence of signs such as oliguria, haematuria, anuria, abdominal pain, and syncope.
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Affiliation(s)
- Taner Sahin
- Deparment of Emergency Medicine, Kayseri City Hospital affiliated with University of Health Sciences, 38100, Kayseri, Turkey.
| | - Ufuk Oner
- Deparment of Emergency Medicine, Kayseri City Hospital affiliated with University of Health Sciences, 38100, Kayseri, Turkey
| | - Omer Baser
- Deparment of Emergency Medicine, Kayseri City Hospital affiliated with University of Health Sciences, 38100, Kayseri, Turkey
| | - Ismail Kurtuncu
- Deparment of Emergency Medicine, Kayseri City Hospital affiliated with University of Health Sciences, 38100, Kayseri, Turkey
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Watanabe T, Mikami M, Katabuchi H, Kato S, Kaneuchi M, Takahashi M, Nakai H, Nagase S, Niikura H, Mandai M, Hirashima Y, Yanai H, Yamagami W, Kamitani S, Higashi T. Quality indicators for cervical cancer care in Japan. J Gynecol Oncol 2019; 29:e83. [PMID: 30207093 PMCID: PMC6189432 DOI: 10.3802/jgo.2018.29.e83] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022] Open
Abstract
Objective We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. Methods A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. Results In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. Conclusion Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
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Affiliation(s)
- Tomone Watanabe
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masanori Kaneuchi
- Department of Obstetrics and Gynecology, Otaru General Hospital, Hokkaido, Japan
| | - Masahiro Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Miyagi, Japan
| | - Hidekatsu Nakai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hitoshi Niikura
- Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan
| | - Masaki Mandai
- Department of Gynecology and Obsteterics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuyuki Hirashima
- Division of Gynecology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Satoru Kamitani
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
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Abstract
ObjectiveThe purpose of this study is to identify incidence of and factors associated with severe late toxicity in women treated with radiation for cervical cancer.Materials and MethodsAll patients with cervical cancer treated with radiation as primary or adjuvant therapy from 2005 to 2017 in a single academic institution were included. Records were reviewed for demographic information, Charlson Comorbidity Index, treatment details, toxicities, and outcomes. Patients with and those without severe late gastrointestinal toxicity (SLGIT), severe late genitourinary toxicity (SLGUT), or any SLGIT or SLGUT, defined as any toxicity (AT), were compared. Overall survival and progression-free survival were also compared.ResultsOf 179 patients identified, 21.2% had AT, 17.3% had SLGIT, and 10% had SLGUT. Estimated AT rate at 3 years was 24.2%. The mean duration of follow-up was 37 months (range, 3–146 months). Most patients (84.1%) received 3-dimensional conformal therapy, and 15.9% received intensity-modulated radiation therapy. Factors associated with AT were lower body mass index (24.9 vs 28.3, P = 0.043), white race (63.2% vs 44%, P = 0.035), and active tobacco smoking during treatment (59.5% vs 40.2%, P = 0.036). Any toxicity was not associated with 3-dimensional versus intensity-modulated radiation therapy planning, low-dose versus high-dose–rate brachytherapy or time to complete radiation treatment. Higher total cumulative radiation dose to clinical target volume was associated with SLGIT. Progression-free survival and overall survival were similar among patients with AT compared to those without toxicity.ConclusionsIn patients with cervical cancer, radiation toxicity is correlated with lower body mass index, white race, and smoking. Despite technologic advances in radiotherapy planning and delivery, toxicity remains high and interventions to reduce the burden of treatment are needed.
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13
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A Population-Based Assessment of Urologic Procedures and Operations After Surgery or Pelvic Radiation for Cervical Cancer. Int J Gynecol Cancer 2018; 28:989-995. [DOI: 10.1097/igc.0000000000001266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe treatment of cervical cancer can result in genitourinary morbidity. We measured selected urologic procedures after the treatment of cervical cancer with either surgery or radiation.MethodsWe used administrative data from the province of Ontario Canada to identify adult women who had nonmetastatic cervical cancer and were treated with surgery or radiation between 1994 and 2014. Study outcomes were surgical or procedure codes representing ureteric repair or fistula repair. Stress incontinence surgery, minimally invasive urologic procedures, open bowel/bladder surgeries, and secondary malignancy were measured to compare between treatment modalities. Multivariable Cox proportional hazards models were used.ResultsOur final cohort consisted of 7311 women (median follow-up, 7.0 years [interquartile range, 2.9–13.3 years]), of which 3354 (44.9%) underwent radiation, and 3957 (54.1%) underwent surgery. After treatment of cervical cancer, ureteral repair was less common after surgery (3.4%) compared with radiation (10.3%) (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.19–0.32). Fistula repair was uncommon (0.9%) and occurred significantly more often in the surgery and radiation group compared with the radiation-alone group (HR, 4.02; 95% CI, 1.80–9.00). Overall, stress incontinence surgery was uncommon (2.2%) but was significantly more likely after surgery versus radiation (HR, 3.73; 95% CI, 2.13–6.53). Minimally invasive urologic procedures were less common after surgery compared with radiation (HR, 0.49; 95% CI, 0.44–0.54). Open bowel/bladder surgeries were similar among treatment modalities, and secondary malignancy was less common after treatment with surgery versus radiation (HR, 0.60; 95% CI, 0.39–0.92;P= 0.02).ConclusionsWomen treated for cervical cancer undergo ureteral stricture interventions at 0.8% per year over the 20 years after their treatment; this risk is higher among women who receive radiation treatment. Fistula repair is rare after cervical cancer.
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14
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Okadome M, Saito T, Kitade S, Ariyoshi K, Shimamoto K, Kawano H, Minami K, Nakamura M, Shimokawa M, Okushima K, Kubo Y, Kunitake N. Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer. Jpn J Clin Oncol 2018; 48:115-123. [PMID: 29136246 DOI: 10.1093/jjco/hyx160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Methods Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Results Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P < 0.01). Two types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P < 0.01). One serious urological complication (intraperitoneal rupture of the bladder) occurred among women who underwent pelvic radiotherapy (0.6% vs. 0%). Conclusions Surgeons should be aware that eGFR is reduced after platinum-based chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up.
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Affiliation(s)
- Masao Okadome
- Gynecology Service, National Kyushu Cancer Center, Fukuoka
| | - Toshiaki Saito
- Gynecology Service, National Kyushu Cancer Center, Fukuoka
| | - Shoko Kitade
- Gynecology Service, National Kyushu Cancer Center, Fukuoka
| | | | - Kumi Shimamoto
- Gynecology Service, National Kyushu Cancer Center, Fukuoka
| | | | - Kazuhito Minami
- Department of Surgery, National Kyushu Cancer Center, Fukuoka
| | | | | | - Kazuhiro Okushima
- Department of Diagnostic Imaging and Nuclear Medicine, National Kyushu Cancer Center
| | - Yuichiro Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, National Kyushu Cancer Center
| | - Naonobu Kunitake
- Department of Radiation Oncology, National Kyushu Cancer Center, Fukuoka, Japan
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Mayadev J, Viswanathan A, Liu Y, Li CS, Albuquerque K, Damato AL, Beriwal S, Erickson B. American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer. Brachytherapy 2017; 16:22-43. [PMID: 28109631 DOI: 10.1016/j.brachy.2016.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Advanced imaging used in combination with brachytherapy (BT) has revolutionized the treatment of patients with cervical cancer. We present a comprehensive review of the literature for definitive radiation with high-dose-rate (HDR) BT. In addition, we investigate potential outcome improvement with image-based brachytherapy (IBBT) compared to studies using traditional Point A dosing. This review extensively investigates acute and late toxicities. METHODS AND MATERIALS This study reviews the literature from 2000 to 2015 with an emphasis on modern approaches including concurrent chemotherapy (chemoRT), radiation, and HDR BT and IBBT. Descriptive statistics and pelvic control (PC), disease-free survival (DFS), and overall survival (OS) outcomes were calculated using weighted means to report pooled analysis of outcomes. RESULTS Literature search yielded 16 prospective, 51 retrospective studies that reported survival outcomes, and 13 retrospective studies that focused on acute and late toxicity outcomes regardless of applicator type. There are 57 studies that report Point A dose specification with 33 having chemoRT, and 10 studies that use IBBT, 8 with chemoRT. Patients receiving radiation and chemoRT with HDR BT in the prospective studies, with >24 months followup, rates of PC were: for RT: 73%, SD: 11; CRT: 82%, SD: 8; DFS-RT: 55%, SD: 10; CRT: 65%, SD: 7; OS-RT: 66%, SD: 7; CRT: 70%, SD: 11. In the retrospective studies, the PC rates (weighted means) for the radiation and chemoradiation outcomes are 75% vs. 80%, and for DFS, the values were 55% vs. 63%, respectively. Comparing patients receiving chemoRT and IBBT to traditional Point A dose specification, there is a significant improvement in PC (p < 0.01) and DFS (p < 0.01) with IBBT. The range of genitourinary late toxicity reported for radiation was Grade 3: 1-6% and for chemoRT 2-20%. The range of late gastrointestinal toxicity for radiation was Grade 3: 4-11% and for chemoRT, 1-11%. For the late gynecologic toxicity, only 1 of the 16 prospective trials report a Grade 1-2 of 17% for radiation and 9% for chemoRT effects. CONCLUSIONS We present concise outcomes of PC, DFS, OS, and toxicity for cervical cancer patients treated with chemoradiation and HDR BT. Our data suggest an improvement in outcomes with the use of IBBT compared with traditional Point A dose prescriptions. In conclusion, HDR BT is a safe, effective modality when combined with IBBT.
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Affiliation(s)
- Jyoti Mayadev
- Department of Radiation Oncology, Davis Medical Center, University of California, Sacramento, CA.
| | - Akila Viswanathan
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Yu Liu
- Department of Biostatistics, Davis Medical Center, University of California, Sacramento, CA
| | - Chin-Shang Li
- Department of Biostatistics, Davis Medical Center, University of California, Sacramento, CA
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Antonio L Damato
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburg Medical Center, Pittsburgh, PA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin Medical Center, Milwaukee, WI
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Goldfarb RA, Fan Y, Jarosek S, Elliott SP. The burden of chronic ureteral stenting in cervical cancer survivors. Int Braz J Urol 2017; 43:104-111. [PMID: 27649113 PMCID: PMC5293390 DOI: 10.1590/s1677-5538.ibju.2016.0667] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/23/2016] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). MATERIALS AND METHODS From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The "no cancer" group was drawn from the 5% Medicare sample. RESULTS 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. CONCLUSIONS The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.
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Affiliation(s)
- Robert A Goldfarb
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yunhua Fan
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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17
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[Pathogenesis of urological complications after radiation therapy]. Urologe A 2016; 56:293-300. [PMID: 28005154 DOI: 10.1007/s00120-016-0292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiation therapy is a treatment modality that is often used in the uro-oncological setting. The common indication for the radiation therapy in the urological sphere is prostate cancer, whether it is used primarily as a radical approach, or postoperatively as adjuvant or salvage therapy. All urological organs are sensitive to radiation injury with the urinary bladder being the most susceptible with a typical cascade including acute and late changes, arising in the dose-dependent manner. The common indication for radiation therapy in urology is prostate cancer, which collaterally affects the urinary bladder and rarely urethra (especially the bulbo-membranous urethra). Ureteral damage and stricture formation is almost always restricted to the cases of intraoperative therapy and external beam radiation therapy for other urological malignancies (gynecological organs, rectum, retroperitoneal soft tissue tumors) and should not be underestimated. Postradiotherapeutic tissue changes, especially of the prostate, can cause difficulties for pathologists and urologists with regard to diagnosis of prostate cancer recurrence and salvage therapy.
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18
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Eng TY, Patel AJ, Ha CS. Rectal and bladder dose reduction with the addition of intravaginal balloons to vaginal packing in intracavitary brachytherapy for cervical cancer. Brachytherapy 2016; 15:312-318. [PMID: 27032995 DOI: 10.1016/j.brachy.2016.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/05/2016] [Accepted: 02/24/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The use of intravaginal Foley balloons in addition to conventional packing during high-dose-rate (HDR) tandem and ovoids intracavitary brachytherapy (ICBT) is a means to improve displacement of organs at risk, thus reducing dose-dependent complications. The goal of this project was to determine the reduction in dose achieved to the bladder and rectum with intravaginal Foley balloons with CT-based planning and to share our packing technique. METHODS AND MATERIALS One hundred and six HDR-ICBT procedures performed for 38 patients were analyzed for this report. An uninflated Foley balloon was inserted into the vagina above and below the tandem flange separately and secured in place with vaginal packing. CT images were then obtained with both inflated and deflated Foley balloons. Plan optimization occurred and dose volume histogram data were generated for the bladder and rectum. Maximum dose to 0.1, 1.0, and 2.0 cm(3) volumes for the rectum and bladder were analyzed and compared between inflated and deflated balloons using parametric statistical analysis. RESULTS Inflation of intravaginal balloons allowed significant reduction of dose to the bladder and rectum. Amount of reduction was dependent on the anatomy of the patient and the placement of the balloons. Displacement of the organs at risk by the balloons allowed an average of 7.2% reduction in dose to the bladder (D0.1 cm(3)) and 9.3% to the rectum (D0.1 cm(3)) with a maximum reduction of 41% and 43%, respectively. CONCLUSIONS For patients undergoing HDR-ICBT, a significant dose reduction to the bladder and rectum could be achieved with further displacement of these structures using intravaginal Foley balloons in addition to conventional vaginal packing.
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Affiliation(s)
- T Y Eng
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - A J Patel
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - C S Ha
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Mizumura N, Imagawa A, Kawasaki M, Okumura S, Toyoda S, Ogawa M. Ascitic fluid with ammonia odor as a symptom of bladder rupture. Acute Med Surg 2015; 3:152-154. [PMID: 29123770 DOI: 10.1002/ams2.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/09/2015] [Indexed: 11/06/2022] Open
Abstract
Case An 88-year-old woman presented with abdominal pain, massive ascites, and acute kidney injury. She was clinically hypervolemic and the computed tomography attenuation value of the ascites was near that of water. Subsequent abdominocentesis revealed ammonia-smelling ascites fluid, leading to a suspicion of urinary tract injury, and a conclusive diagnosis of spontaneous bladder rupture was achieved using cystography. Outcome The patient was managed conservatively with antibiotics, percutaneous drainage, and bladder catheter. As a result, she was discharged with normal renal function. Conclusion The diagnosis of bladder rupture is difficult, and is rarely confirmed in the absence of a diagnostic suspicion. This case indicates that ascitic fluid odor, patient volume status, and the computed tomography attenuation value of ascites are potential indicators of bladder rupture.
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Affiliation(s)
- Naoto Mizumura
- Department of Surgery Bellland General Hospital Sakai Osaka Japan
| | - Atsuo Imagawa
- Department of Surgery Bellland General Hospital Sakai Osaka Japan
| | | | - Satoshi Okumura
- Department of Surgery Bellland General Hospital Sakai Osaka Japan
| | - Sho Toyoda
- Department of Surgery Bellland General Hospital Sakai Osaka Japan
| | - Masao Ogawa
- Department of Surgery Bellland General Hospital Sakai Osaka Japan
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20
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Narayan K, Lin MY. Staging for cervix cancer: Role of radiology, surgery and clinical assessment. Best Pract Res Clin Obstet Gynaecol 2015; 29:833-44. [PMID: 25898789 DOI: 10.1016/j.bpobgyn.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/27/2015] [Indexed: 12/20/2022]
Abstract
Staging is necessary in determining the extent of disease, its prognosis and in the formulation of optimal treatment protocols for patients with cancer. Clinical examination of patients and subsequent histopathological assessment when available has traditionally been used to determine the application of different primary and adjuvant treatment modalities. Over the years, surgery, radiotherapy and chemotherapy all have been used either singly or in combinations, and the resulting survival and patterns of failure studies have contributed much in the development of less toxic and more effective protocols. All three modalities of treatments work through separate mechanisms, and they are effective in different stages of cervix cancer. Even within the same stage, the extent of the disease, tumour volume, tissue infiltration and lymph-node metastases requires the use of differing protocols for the disease control. More recently, advances in magnetic resonance imaging (MRI) and positron emission tomography/computerised tomography (PET/CT) have made it possible to examine many of the prognostic factors non-invasively. In addition to clinical assessment, surgical and radiological staging has enabled us to triage patients far more accurately for surgery or for primary radiotherapy, such as unnecessary multimodality treatments are avoided. Only patients with poor prognosis are subjected to a combined modality treatment. Those with poorer prognosis still can be selected for clinical studies exploring new treatment.
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Affiliation(s)
- Kailash Narayan
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
| | - Ming Yin Lin
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
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21
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Yang L, Lv Y. Possible risk factors associated with radiation proctitis or radiation cystitis in patients with cervical carcinoma after radiotherapy. Asian Pac J Cancer Prev 2014; 13:6251-5. [PMID: 23464440 DOI: 10.7314/apjcp.2012.13.12.6251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Radiation proctitis and radiation cystitis are major complications for patients with cervical carcinoma following radiotherapy. In the present study, we aimed to determine the potential risk factors for the development of radiation proctitis and radiation cystitis after irradiation. A total of 1,518 patients with cervical carcinoma received external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDRICB) in our hospital. The incidences of radiation proctitis and radiation cystitis were recorded and associations with different factors (age, time period, tumor stage) were analyzed with χ2 (chi-squared) and Fisher exact tests. We found that 161 and 94 patients with cervical carcinoma were diagnosed with radiation proctitis and radiation cystitis, respectively, following radiotherapy. The prevalence of Grade I-II radiation proctitis or radiation cystitis was significantly lower than that of Grade III (radiation proctitis: 3.82% vs. 6.76%, P <0.05; radiation cystitis: 2.31% vs. 3.87%, P < 0.05) and was significantly enhanced in patients with late stage (IIIb) tumor progression compared to those in early stage (Ib, IIa) (P < 0.05). Moreover, the incidence of radiation proctitis and cystitis was not correlated with age or, time period following radiation, for each patient (P > 0.05). These observations indicate that a late stage of tumor progression is a potential risk factor for the incidence of radiation proctitis and cystitis in cervical carcinoma patients receiving radiotherapy.
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Affiliation(s)
- Lin Yang
- Department of Radiation Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
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22
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Shin JY, Yoon SM, Choi HJ, Lee SN, Kim HB, Joo WC, Song JH, Kim MJ, Lee SW. A Case of Post-radiotherapy Urethral Stricture with Spontaneous Bladder Rupture, Mimicking Obstructive Uropathy due to Cancer Metastasis. Electrolyte Blood Press 2014; 12:26-9. [PMID: 25061470 PMCID: PMC4105386 DOI: 10.5049/ebp.2014.12.1.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
Non-traumatic, spontaneous urinary bladder rupture is a rare complication of urethral stricture. Furthermore, its symptoms are often nonspecific, and misdiagnosis is common. The authors experienced a case of urethral stricture with spontaneous bladder rupture and bilateral hydronephrosis, mimicking obstructive uropathy attributed to cancer metastasis. A 55-year-old woman was admitted with abdominal pain and distension, oliguria, and an elevated serum creatinine level. She had undergone radical hysterectomy for uterine cervical cancer and received post-operative concurrent chemoradiation therapy 13 years previously. Non-contrast enhanced computed tomography showed massive ascites and bilateral hydronephrosis. The initial diagnosis was acute kidney injury due to obstructive uropathy caused by malignant disease. After improvement of her renal function by bilateral percutaneous nephrostomy catheterization, contrast-enhanced computed tomography and a cytologic examination of ascites showed no evidence of malignancy. However, during retrograde pyelography, a severe urethral stricture was found, and subsequent cystography showed leakage of contrast into the peritoneal cavity and cystoscopy revealed a defect of the posterior bladder wall. After urethral dilatation and primary closure of the bladder wall, acute kidney injury and ascites were resolved.
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Affiliation(s)
- Jun Young Shin
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sang Min Yoon
- Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Hyuck Jae Choi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Si Nae Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hai Bong Kim
- Division of Nephrology, Department of Internal Medicine, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Woo Chul Joo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Moon-Jae Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Abstract
Several urological complications can occur after treatment of cervical cancer. Stage IB and IIA cervical tumours are mainly treated by radical hysterectomy; advanced-stage tumours are treated by chemoradiotherapy. In the past two decades, a decrease in complications has been seen due to improvements in therapy, although the exact incidence of lower urinary tract dysfunction is unknown. The main urological complications after radical surgery are hypocontractility of the bladder, detrusor overactivity, incontinence, low-compliance bladder, fistula and hydronephrosis. As a result of improved neuroanatomical knowledge, and consequently nerve-sparing surgery, bladder morbidity has been decreasing. Late radiation-induced urological complications include haemorrhagic cystitis, ureteric stenosis, low-compliance bladder and fistulas. Owing to technological improvements, such as dose reduction and decreased radiation fields, a decrease in radiation morbidity has been observed since 1990.
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Affiliation(s)
- Esther M K Wit
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
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Sewell JM, Rao A, Elliott SP. Validating a Claims-based Method for Assessing Severe Rectal and Urinary Adverse Effects of Radiotherapy. Urology 2013; 82:335-40. [DOI: 10.1016/j.urology.2013.02.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/29/2013] [Accepted: 02/09/2013] [Indexed: 12/01/2022]
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Affiliation(s)
- M C McCullough
- Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL, USA
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Craggs B, Michielsen D. Conservative treatment of an intraperitoneal bladder perforation. Cent European J Urol 2011; 64:47-9. [PMID: 24578862 PMCID: PMC3921696 DOI: 10.5173/ceju.2011.01.art11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 01/27/2011] [Accepted: 02/22/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The management of bladder rupture depends on its anatomical location. MATERIAL AND METHODS Case report and review of the pertinent English language literature. RESULTS A 56-year-old man with history of an anterior rectum resection with partial cystectomy presented with signs of acute renal failure, and later with a tender, distended abdomen. Work-up including serum and ascites biochemistry, cystoscopy, and CT cystography diagnosed urinary ascites. The small intraperitoneal bladder rupture was treated conservatively via continued urinary drainage under urinary antibiotic prophylaxis until closure. CONCLUSION A conservative treatment of a small intraperitoneal bladder perforation is possible under certain conditions.
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Affiliation(s)
- Barbara Craggs
- Department of Urology, UZ Brussel, Free University of Brussels, Belgium
| | - Dirk Michielsen
- Department of Urology, UZ Brussel, Free University of Brussels, Belgium
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27
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Long-term urinary adverse effects of pelvic radiotherapy. World J Urol 2010; 29:35-41. [PMID: 20959990 DOI: 10.1007/s00345-010-0603-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 09/28/2010] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Radiation for tumors arising in the pelvis has been utilized for over a 100 years. Adverse effects (AEs) of radiotherapy (RT) continue to accumulate with time and are reported to show decades after treatment. The benefit of RT for pelvic tumors is well described as is their acute AEs. Late AEs are less well described. The burden of treatment for the late AEs is large given the high utilization of RT. REVIEW For prostate cancer, 37% of patients will receive radiation during the first 6 months after diagnosis. Low-and high-grade AEs are reported to occur in 20-43 and 5-13%, respectively, with a median follow-up of ~60 months. For bladder cancer, the grade 2 and grade 3 late AEs occur in 18-27 and 6-17% with a median follow-up of 29-76 months. For cervical cancer, the risk of low-grade AEs following radiation can be as high as 28%. High-grade AEs occur in about 8% at 3 years and 14.4% at 20 years or ~0.34% per year. Radiation AEs appear to be less common or at least less well studied after radiation for rectal and endometrial cancers. CONCLUSION Properly delineating the rate of long-term AEs after pelvic RT is instrumental to counseling patients about their options for cancer treatment. Further studies are needed that are powered to specifically evaluate long-term AEs.
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Galbraith JG, Butler JS, McGreal GT. Opioid toxicity as a cause of spontaneous urinary bladder rupture. Am J Emerg Med 2010; 29:239.e1-3. [PMID: 20825888 DOI: 10.1016/j.ajem.2010.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022] Open
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Goto S, Yamadori M, Igaki N, Kim JI, Fukagawa M. Pseudo-azotaemia due to intraperitoneal urine leakage: a report of two cases. NDT Plus 2010; 3:474-6. [PMID: 25984058 PMCID: PMC4421708 DOI: 10.1093/ndtplus/sfq107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 05/21/2010] [Indexed: 11/12/2022] Open
Abstract
Ascites, oliguria and increasing serum creatinine levels are often noted in patients with acute kidney injury. However, these presentations are also observed in patients with intraperitoneal urinary leakage. Bladder perforation without obvious trauma is sometimes mistaken for acute kidney injury. We report two cases of bladder perforation resembling acute kidney injury. The first case was a 37-year-old woman with delayed intraperitoneal urinary leakage following total abdominal hysterectomy, and the second was a 70-year-old woman with spontaneous bladder perforation. Although the initial diagnosis in both cases was acute kidney injury, rupture of the urinary bladder was later identified.
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Affiliation(s)
- Shunsuke Goto
- Division of Nephrology and Kidney Center , Kobe University School of Medicine , Kobe , Japan ; Department of Internal Medicine , Takasago Municipal Hospital , Takasago , Japan
| | - Mari Yamadori
- Division of Nephrology and Kidney Center , Kobe University School of Medicine , Kobe , Japan ; Department of Internal Medicine , Chibune General Hospital , Osaka , Japan
| | - Naoya Igaki
- Department of Internal Medicine , Takasago Municipal Hospital , Takasago , Japan
| | - John-Il Kim
- Department of Internal Medicine , Chibune General Hospital , Osaka , Japan
| | - Masafumi Fukagawa
- Division of Nephrology and Kidney Center , Kobe University School of Medicine , Kobe , Japan ; Division of Nephrology and Metabolism, Department of Medicine , Tokai University School of Medicine , Ishehara , Japan
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Lin ACM, Juang GD, Huang CH, Tso CY. An unusual cause of iatrogenic bladder rupture. Am J Emerg Med 2006; 24:512-4. [PMID: 16787822 DOI: 10.1016/j.ajem.2005.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 11/29/2005] [Indexed: 11/18/2022] Open
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Matsuura Y, Kawagoe T, Toki N, Tanaka M, Kashimura M. Long-standing complications after treatment for cancer of the uterine cervix--clinical significance of medical examination at 5 years after treatment. Int J Gynecol Cancer 2006; 16:294-7. [PMID: 16445648 DOI: 10.1111/j.1525-1438.2006.00354.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study is to investigate the side effect in patients who survived for more than 5 years after initial treatment for invasive cervical cancer. Between January 1984 and December 1997, 341 patients underwent primary treatment for invasive cervical cancer. One hundred nine patients who underwent medical examinations at 5 years after primary treatment were reviewed. The patients were divided into three groups: radical surgery alone (group A), radiotherapy alone (group B), and radical surgery with postoperative radiotherapy (group C). Dysuria was seen in 8%, and positive catheterized urine culture was noted in about 20% of groups A and C. Hydronephrosis was seen in 2% and 9% of groups A and B, respectively. Colitis or ulcer detected by proctosigmoidoscopy was noted in 15%, 50%, and 43% of groups A, B, and C, respectively, frequently observed in radiotherapy group (P= 0.0029). Lymphocyst was still present in 6% of group A, and leg edema was noted in 14%, 6%, and 15% of groups A, B, and C, respectively. Long-standing abnormal findings including urinary and bowel complications were presented in this study. Periodic physical examination after treatment should be performed because complications existed over a long time.
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Affiliation(s)
- Y Matsuura
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health Japan, Iseigaoka 1-1, Yahata Nisahi-Ku, Kitakyushu, Fukuoka 807-8555, Japan.
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Kato A, Yoshida KI, Tsuru N, Ushiyama T, Suzuki K, Ozono S, Hishida A. Spontaneous rupture of the urinary bladder presenting as oliguric acute renal failure. Intern Med 2006; 45:815-8. [PMID: 16880706 DOI: 10.2169/internalmedicine.45.1748] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 64-year-old female was admitted to hospital for acute abdominal pain with ascites. The patient had received postoperative pelvic irradiation for carcinoma of the uterine cervix 7 years previously. Serum creatinine (Scr) was elevated to 2.70 mg/dl, and urinary output was reduced to below 200 ml/day. Cystoscopy revealed a small perforation from the bladder diverticulum. Following transurethral catheterization, urinary output was promptly increased, and Scr was returned to 0.65 mg/dl 4 days later. This rare case suggested that spontaneous rupture of the urinary bladder following postoperative radiotherapy could occur very late with laboratory features of oliguric acute renal failure.
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Affiliation(s)
- Akihiko Kato
- Division of Blood Purification, cUniversity School of Medicine, Shizuoka
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Tsokos M, Schulz F. Tödliche Harnblasenruptur bei Blasentamponade nach transurethraler Resektion der Prostata. Rechtsmedizin (Berl) 2005. [DOI: 10.1007/s00194-005-0343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malaker K, Shukla V, D'Souza H, Weatherburn H. Minimizing urinary bladder radiation dose during brachytherapy for carcinoma of the cervix using balloon inflation technique. Int J Radiat Oncol Biol Phys 2005; 61:257-66. [PMID: 15629619 DOI: 10.1016/j.ijrobp.2004.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Revised: 03/19/2004] [Accepted: 05/03/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE Radiotherapy is effective in treating cancer of the cervix. However, its success is associated with significant morbidity of the urinary bladder. This study has been designed to reduce the radiotherapy dose from the brachytherapy component of cervical cancer treatment to the urinary bladder to minimize radiation-induced morbidity. MATERIALS AND METHODS By inflating the balloon of a Foley catheter at the anterior fornix region, attempts were made to displace the urinary bladder in patients undergoing gynecological intracavitary brachytherapy. The radiation dose to the urinary bladder was then studied in 12 insertions without and 31 insertions with balloon inflation. RESULTS The increase in the distance from the intrauterine tandem source to a reference point in the base of the bladder and the resultant decrease in the radiation dose have been determined. A highly significant reduction in the radiation dose with an increase in distance between the source applicator and bladder base were achieved (p < 0.01 in both cases). CONCLUSION A significant reduction in radiation dose to the bladder base can be achieved by the technique described in this study. A three-dimensional plan generated using CT images can demonstrate the drawback of ICRU-38 bladder reference point. The technique is simple consistent and reproducible within an acceptable range.
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Affiliation(s)
- Kamal Malaker
- Radiation Oncology Section, Princess Norah Oncology Centre, Jeddah, Saudi Arabia.
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Cybulski Z, Roszak A, Talaga Z, Grabiec A, Kaźmierska J. Urinary tract infections in patients with malignant neoplasms of the genitourinary system. Rep Pract Oncol Radiother 2005. [DOI: 10.1016/s1507-1367(05)71078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Eng TY, Fuller CD, Cavanaugh SX, Blough MM, Sadeghi A, Herman T. Significant rectal and bladder dose reduction via utilization of foley balloon catheters in high-dose-rate tandem and ovoid intracavitary brachytherapy of the uterine cervix. Int J Radiat Oncol Biol Phys 2004; 59:174-8. [PMID: 15093914 DOI: 10.1016/j.ijrobp.2003.09.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 09/22/2003] [Indexed: 11/20/2022]
Abstract
PURPOSE To ascertain the potential for dose reduction to bladder and rectal points by using intravaginal Foley balloon catheters as a mechanism for structural displacement during tandem and ovoid high-dose-rate intracavitary brachytherapy of the uterine cervix. METHODS AND MATERIALS In 22 patients, two Foley balloons were placed intravaginally, with one balloon placed anterior to the tandem and one posterior, as close to the flange as patient geometry allowed. A series of 57 consecutive digitized treatment plans was assessed with and without liquid contrast inflation of Foley catheter balloons. Planning X-rays were acquired and digitized. Software calculated dose was then defined for two bladder and two rectal points, both with and without Foley balloon inflation. Results were then assessed using parametric statistical analysis. RESULTS Collectively and between equivalent points, a statistically significant (p < or = 0.01) diminution in calculated dose was observed with inflation of intracavitary balloon catheters, with a mean reduction in calculated dose of 16% and 17.6% for bladder and rectal points, respectively. CONCLUSION The potential advantages available from dose reduction using intracavitary balloon catheters include decreased high-dose-rate-induced organ toxicity, case-by-case customizability, and low cost of implementation. As such, further exploration of this technique is warranted.
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Affiliation(s)
- Tony Y Eng
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, and the Cancer Therapy Research Center, San Antonio, TX 78284-7800, USA.
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Affiliation(s)
- Adam G Baseman
- Department of Urology, University of Texas Southwestern Medical School and Children's Hospital, Dallas 75390-9110, USA
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Jensen PT, Klee MC, Groenvold M. Validation of a questionnaire for self-rating of urological and gynaecological morbidity after treatment of gynaecological cancer. Radiother Oncol 2002; 65:29-38. [PMID: 12413672 DOI: 10.1016/s0167-8140(02)00263-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Patient self-assessment of symptom severity provides clinicians and researchers with important information. It is crucial to evaluate the validity of a self-assessment questionnaire in the context of its intended use. The objective of this study was to evaluate the validity of the uro-gynaecological questionnaire (UGQ), a new instrument for patient self-assessment of urological-, genital-, menopausal-, and pain symptomatology in gynaecological cancer patients. MATERIAL AND METHODS The UGQ was developed after literature review, patient- and expert interviews and pilot testing. From February 1992 to October 1992, 88 gynaecological cancer patients were invited to participate in a validation study after the initiation of their primary radiotherapy or chemotherapy. The method of validation investigated whether patients and researchers interpreted the items of the questionnaire in the same way. The patient's written response before interview was compared with an observer rating of the patient's open-ended audio-taped responses to the same questionnaire, administered as an interview. Qualitative recordings by the observer were made to describe potential misinterpretations. RESULTS The agreement between the patient's and the observer's ratings was high: the median overall agreement was 0.91 (range 0.71-1.00) and the median kappa was 0.88 (range 0.45-1.00). The quantitative and the qualitative results identified a few minor validity problems; especially, the issue of selective reporting, i.e. some patients only reporting those symptoms they considered relevant for the study, which may lead to systematic errors. CONCLUSIONS The results strongly suggest that patients interpret the UGQ items as intended, i.e. they are valid. The UGQ is recommended for patient self-assessment of uro-gynaecological morbidity in gynaecological cancer patients.
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Affiliation(s)
- Pernille Tine Jensen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark
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