Русский
Reconstructive procedures in women with irradiation injuries of urinary tract: change of a paradigm
DOI: https://dx.doi.org/10.18565/urology.2024.2.11-17
Loran O.B., Guspanov R.I., Kotov S.V., Seregin A.V., Morozov A.D., Bogdanov D.A.
1) Russian Medical Academy of Continuous Professional Education (RMACPE), Department of Urology and Surgical Andrology, Moscow, Russia; 2) FGAOU VO Pirogov Russian National Research University, Moscow, Russia; 3) S.P. Botkin’s State Clinical Hospital, Moscow, Russia; 4) GBUZ MMKC “Kommunarka”, Moscow, Russia
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.
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.
About the Autors
Corresponding author: R.I. Guspanov – Ph.D., associate professor at the Department of Urology and Andrology of Pirogov Russian National Research Medical University, Moscow, Russia; e-mail: uroguspanov@yandex.ru
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