Reconstructive procedures in women with irradiation injuries of urinary tract: change of a paradigm
- Autores: Loran O.B.1,2, Guspanov R.I.3,4, Kotov S.V.3,4, Seregin A.V.1,2, Morozov A.D.2, Bogdanov D.A.3,4
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Afiliações:
- Russian Medical Academy of Continuous Professional Education (RMACPE)
- S.P. Botkin’s State Clinical Hospital
- FGAOU VO Pirogov Russian National Research University
- GBUZ MMKC “Kommunarka”
- Edição: Nº 2 (2024)
- Páginas: 11-17
- Seção: Original Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/633478
- DOI: https://doi.org/10.18565/urology.2024.2.11-17
- ID: 633478
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Resumo
Introduction. Radiation therapy is one of the main methods of treating pelvic malignant tumors, which provides good oncological results. Specific features of the pelvic anatomy may result in various radiation injuries of adjacent organs, which are complicated by genitourinary fistulas, post-radiation fibrosis with the formation of hydronephrosis, microcyst, reducing the quality of life.
Aim. To describe the relevance and importance of the correct choice of surgical treatment in patients with post-radiation urinary tract injuries.
Materials and methods. The group of irradiation injuries of the urinary tract included 60 patients aged 39–65 years. 19 (31.7%) women with various post-radiation ureteral injurie, who underwent reconstructive surgery using isolated bowel segments, were included in the study group.
Results. Substitution of the ureter by intestinal segment in patients with extensive post-radiation ureteral strictures provides good functional results. During follow-up computed tomography, an absence of urinary tract obstruction was confirmed in 16 (84.2%) patients, while in 3 (15.8%) cases an obstruction was diagnosed, followed by nephrectomy due to loss of function in 1 woman (5.3%). When assessing renal function using the dynamic nuclear scintigraphy, improvement in function was revealed in 14 (73.7%) patients, stabilization in 2 (10.5%), deterioration in 3 (15.8%). Histological examination revealed that inflammatory infiltration and the absence of a clear margins of the stricture area were more pronounced in patients who had had internal ureteral stent prior to reconstruction. A number of clinical cases demonstrating the treatment tactics of this group of patients is presented in the article.
Conclusion. Based on the extensive experience of two centers and long follow-up, we suggest scientifically proven approach to surgical treatment of radiation injuries of the urinary tract, the implementation of which will significantly improve medical and social rehabilitation.
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Sobre autores
O. Loran
Russian Medical Academy of Continuous Professional Education (RMACPE); S.P. Botkin’s State Clinical Hospital
Email: olegloran@gmail.com
ORCID ID: 0000-0002-7531-1511
Academician of RAS, Ph.D., MD, professor, Chief of Department of Urology and Surgical Andrology
Rússia, Moscow; MoscowR. Guspanov
FGAOU VO Pirogov Russian National Research University; GBUZ MMKC “Kommunarka”
Autor responsável pela correspondência
Email: uroguspanov@yandex.ru
ORCID ID: 0000-0002-2944-2668
Ph.D., associate professor at the Department of Urology and Andrology of Pirogov Russian National Research Medical University
Rússia, Moscow; MoscowS. Kotov
FGAOU VO Pirogov Russian National Research University; GBUZ MMKC “Kommunarka”
Email: urokotov@mail.ru
ORCID ID: 0000-0003-3764-6131
Ph.D., MD, professor, Head of the Department of Urology and Andrology
Rússia, Moscow; MoscowA. Seregin
Russian Medical Academy of Continuous Professional Education (RMACPE); S.P. Botkin’s State Clinical Hospital
Email: av_seregin@mail.ru
ORCID ID: 0000-0002-5842-7344
Ph.D., MD, professor, Head of the Urologic Department No 41 of S.P. Botkin city clinical hospital
Rússia, Moscow; MoscowA. Morozov
S.P. Botkin’s State Clinical Hospital
Email: renat@guspanov.ru
Ph.D., urologist of the Urologic Department No 41
Rússia, MoscowD. Bogdanov
FGAOU VO Pirogov Russian National Research University; GBUZ MMKC “Kommunarka”
Email: renat@guspanov.ru
ORCID ID: 0000-0001-6847-5684
Ph.D. student at the Department of Urology and Andrology of Pirogov Russian National Research Medical University
Rússia, Moscow; MoscowBibliografia
- American Cancer Society. Cancer Facts & Figures 2018. Available at www. cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018. html. Accessed January 8, 2018.
- McIntyre J.F., Eifel P.J., Levenback C., Oswald M.J. Ureteral stricture as a late complication of radiotherapy for stage IB carcinoma of the uterine cervix. Cancer. 1995;75(3):836-43. doi: 10.1002/1097-0142(19950201)75:3<836::aid-cncr2820750315>3.0.co;2-a. PMID: 7828135.
- Demanes D.J., Banerjee R., Cahan B.L., Lee S.P., Park S.J., Fallon J.M., Reyes P., Van TQ, Steinberg ML, Kamrava MR. Ureteral stent insertion for gynecologic interstitial high-dose-rate brachytherapy. Brachytherapy. 2015;14(2):245–251. doi: 10.1016/j.brachy.2014.11.013. Epub 2014 Dec 31. PMID: 25556864.
- Wit E.M., Horenblas S. Urological complications after treatment of cervical cancer. Nat Rev Urol. 2014;11(2):11–27. doi: 10.1038/nrurol.2013.323. Epub 2014 Jan 28. PMID: 24473416.
- Krikunova L.I. Radiation therapy of uterine cancer. Practical oncology. 2004;5(1):34–36. Russian (Крикунова Л.И. Лучевая терапия рака матки. Практическая онкология. 2004;5(1):34–36).
- 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(2):115–123. doi: 10.1093/jjco/hyx160. PMID: 29136246.
- Buglione M., Toninelli M., Pietta N. et al. Post-radiation pelvic disease and ureteral stenosis: physiopathology and evolution in the patient treated for cervical carcinoma. Review of the literature and experience of the Radium institute. Arch. Ital. Urol. Androl. 2002;74(1):6–11.
- Beller H.L., Rapp D.E., Zillioux J., Abdalla B., Duska L.R., Showalter T.N., Krupski T.L., Cisu T., Congleton J.Y., Schenkman N.S.. Urologic Complications Requiring Intervention Following High-dose Pelvic Radiation for Cervical Cancer. Urology. 2021;151:107–112. doi: 10.1016/j.urology.2020.09.011. Epub 2020 Sep 20. PMID: 32961221.
- Toia B., Seth J., Ecclestone H., Pakzad M., Hamid R., Greenwell T., Ockrim J. Outcomes of reconstructive urinary tract surgery after pelvic radiotherapy. Scand J Urol. 2019;53(2-3):156–160. doi: 10.1080/21681805.2019.1611631. Epub 2019 May 15. PMID: 31092116.
- Welk B., Wallis C., D’Souza D., McGee J., Nam R.K. A Population-Based Assessment of Urologic Procedures and Operations After Surgery or Pelvic Radiation for Cervical Cancer. Int J Gynecol Cancer. 2018;28(5):989–995. doi: 10.1097/IGC.0000000000001266. PMID: 29664839.
- Kan D.V. Handbook of obstetric and gynecological urology. M.: Medicine, 1986. 488 p. Russian (Кан Д.В. Руководство по акушерской и гинекологической урологии. М.: Медицина, 1986. 488 с.).
- Pomer S., Karcher G., Simon W. Cutaneous ureterostomy as last resort treatment of intractable haemorrhagic cystitis following radiation. Br J Urol. 1983;55(4):392–394. doi: 10.1111/j.1464-410x.1983.tb03329.x. PMID: 6883044.
- Schmidt J.D., Hawtrey C.E., Buchsbaum H.J. Transverse colon conduit: a preferred method of urinary diversion for radiation-treated pelvic malignancies. J Urol. 1975;113(3):308–313. doi: 10.1016/s0022-5347(17)59469-0. PMID: 1090758.
- Beckley S., Wajsman Z., Pontes J.E., Murphy G. Transverse colon conduit: a method of urinary diversion after pelvic irradiation. J Urol. 1982;128(3):464–468. doi: 10.1016/s0022-5347(17)52999-7. PMID: 7120546.
- Ahyai S.A., Sayedahmed K., Engel O., Chun F., Dahlem R., Fisch M. Harnableitung und Dickdarm : Das Transversumconduit und der Transversumpouch [Urinary diversion and colon: transverse conduit and transverse pouch]. Urologe A. 2012;51(7):937–946. German. doi: 10.1007/s00120-012-2907-5. PMID: 22772492.
- Pycha A, Trenti E. Hohe Harnableitung nach Bestrahlung im kleinen Becken [High urinary diversion after irradiation to the lesser pelvis]. Urologe A. 2020;59(4):4169425. German. doi: 10.1007/s00120-020-01156-2. PMID: 32130447.
- Ungar L., Palfalvi L., Novak Z. Primary pelvic exenteration in cervical cancer patients. Gynecol Oncol. 2008;111(2 Suppl):S9–12. doi: 10.1016/j.ygyno.2008.07.041. Epub 2008 Sep 5. PMID: 18775558.
- Pokharkar A., Kammar P., D’souza A., Bhamre R., Sugoor P., Saklani A. Laparoscopic Pelvic Exenteration for Locally Advanced Rectal Cancer, Technique and Short-Term Outcomes. J Laparoendosc Adv Surg Tech A. 2018;28(12):1489–1494. doi: 10.1089/lap.2018.0147. Epub 2018 May 9. PMID: 29741977.
- Loran O.B., Sinyakova L.A., Guspanov R.I. Radiation damage to the organs of the urinary system in oncogynecological diseases. M.: Medical Information Agency, 2019. 120 p. Russian (Лоран О.Б., Синякова Л.А., Гуспанов Р.И. Лучевые повреждения органов мочевой системы при онкогинекологических заболеваниях. М.: Медицинское информационное агентство, 2019. 120 с.).
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