Ureteric complications following type 3-4 radical hysterectomy in patients with locally advanced cervical cancer.

In order to assess the incidence, and factors influencing the risk of ureteric complications in patients with stage IB-IIA < 4 cm, IIB, II, III cervical cancer who underwent type 3-4 radical hysterectomy following neoadjuvant chemotherapy, data from 157 consecutive patients were analyzed. Among these, 90 patients entered a randomized study aimed to assess the efficacy of a ureteric stent in preventing ureteric complications. In these patients one ureter, randomly chosen, was stented before surgery, the surgeon being unaware of which. Ureteric dissection consisted in the isolation of the ureter from the superficial and deep layer of the vesico-uterine ligament and cutting of the ligament 1 cm from (type 3) or at bladder insertion (type 4). To prevent the distal ureter from being immersed in pelvic dead space, a protecting wall approximating the stumps of the anterior and posterior parametria was performed.Ureteric fistula was observed in 11 (7%) patients of the whole series of 157 patients and stricture in three (2%) patients. The incidence of fistula declined from 13% of the first 31 patients to 0% of the last 36 patients. Chi-square analysis showed that ureteric stenting, cumulative surgical experience expressed as date of surgery, age and the construction of the protecting wall significantly affected the risk for fistula formation(P > 0.05). Mild ureteric dilatation was observed in 53% of ureters not stented. Spontaneous resolution was observed in all patients at 6-12 months. Fistula was the most striking ureteric complication following type 3-4 radical hysterectomy. Increased skill of the operating team may explain the reduced frequency of ureteric damage over time, since this made it possible to actually respect the periureteric plexus which is the only vessel to the distal ureter after cutting the ureteric blood supply from the hypogastric artery. Although the ability of a ureteric stent to prevent fistula formation was shown, stent-induced morbidity and the importance of surgical skill in preventing ureteric damage suggest that routine stent utilization be avoided. [ABSTRACT FROM AUTHOR]