[Clinical examination and therapies of hydronephrosis after radical hysterectomy]

Post-Hysterectomy Transient Hydronephrosis: A Prospective Study

Objective: To determine the incidence and importance of transient asymptomatic hydronephrosis following total hysterectomy.

Materials and methods: In a prospective study over 4 year, 368 women were studied who had undergone a total abdominal or vaginal hysterectomy. Totally, 95% of operations were done for benign diseases (abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, etc.) and 5% were performed for uterine malignancy. Renal ultrasonography was performed before and 3, 7 and 28 days after the surgery for diagnosing hydronephrosis. Intravenous urography was performed in patients with either persistent/progressive or symptomatic hydronephrosis.

Results: There was no intraoperative identifiable ureteral injury. Hydronephrosis was seen in 35 (9.5%), 21 (5.7%), and 1 (0.27%) patients at days 3, 7 and 28 after the operation, respectively. The degree of hydronephrosis was graded I, II or III. Considering the frequency and severity of hydronephrosis, the right kidney was affected more. Hydronephrosis correlated significantly with indication, duration and route of surgery as well as patient's age. All kidneys improved spontaneously, except one case which needed ureteral stenting with no surgical intervention (p=0.05).

Conclusion: Transient hydronephrosis could occur after simple total hysterectomy despite the absence of any obvious intraoperative ureteral injury. It is noted in 9.5% of the patients within three days after the non-complicated surgery. The clinical course may be continued until one month.

Neurogenic Bladder Dysfunction in Cancer Patients after Operations on the Pelvic Organs

The review is devoted to the generalization and analysis of domestic and foreign works describing the mechanism of development of neurogenic dysfunction of the bladder after surgery on the pelvic organs in cancer patients. All modern authors agree that the cause of these disorders is trauma of the pelvic nerves and interruption of the reflex arc. Unfortunately, when removing malignant tumors of the pelvic organs, urological complications are difficult and often impossible to avoid. This is due to the complex neuroanatomy of the bladder, its proximity to the rectum, the uterus, as well as the volume and radicality of cancer operations. The article shows that if the parasympathetic ganglia are damaged, there is a violation of the evacuation function of the bladder and a weakening or absence of the urge to urinate. If the sympathetic nervous system is damaged in isolation, on the contrary, an increase in the detrusor tone, intravesical pressure and a decrease in the capacity of the bladder is observed, which is in conditions of low bladder sphincter tone causes imperative urges, frequent urination and incontinence. Prior radiation therapy also affects the development of urological complications. Postradiated soft tissue changes, ischemia, fibrosis lead to great technical difficulties during surgery. In addition, factors that are important in the development of pelvic disorders in this category of patients include urinary system diseases and metabolic – endocrine disorders in case history.