The Changes and Natural Progress of Hydronephrosis Following Radical Hysterectomy: A Prospective Study

Kim, Chul; Song, Yong Sang; Kim, Hyeon Hoe

Abstract

PURPOSE: A prospective study was carried out to investigate the natural progress of hydronephrosis following a radical hysterectomy.
MATERIALS AND METHODS
Thirty four patients, with localized cervical cancer, underwent a radical hysterectomy, without intraoperatively identifiable injury to the ureter, which were performed by a single gynecologist. Intravenous pyelography was routinely performed preoperatively, and in the second and fourth postoperative week. The degree of hydronephrosis (HN) was categorized (grade I-IV).
RESULTS
Preoperative urography showed no abnormal finding in any of the patients, but one with a unilateral duplex kidney. HN was found in 10 units of the upper tract (grade II: 8, III: 1, IV: 1) in 7 patients (20.6%) in the second postoperative week: 4 unilateral (1 right and 3 left) and 3 bilateral. All the ureteral narrowing was found in the distal ureter. The HN disappeared in 4 units of 3 patients, while it was aggravated in 2 units of 2 patients with bilateral pathology in the fourth week. By the third postoperative month, no HN units where aggravated, and all the units of HN had disappeared by the sixth postoperative month. The presence of HN has significant correlation with the pathological stage (Ib 15.8% vs. IIb 50.0%) (p<0.05).
CONCLUSIONS
The hydronephrosis was identified after a radical hysterectomy, even without intraoperatively recognizable injury to the ureter. However, most of the patients with HN improved spontaneously, and needed no ureteral stenting or surgical intervention.