AIM: A retrospective audit from a urological center focused on urological fistulas that directly connect with the treatment of gynecological malignancy. Ureteroarterial fistulas, i.e., pathological communication between the ureter and the artery, are discussed in more detail. MATERIALS AND METHODS: Over a period of ten years, from 2011 to 2020, a group of 47 patients with a diagnosis of urinary fistula was retrospectively evaluated. These patients, with a history of treatment for gynecological malignancy, were sent to our clinic from local and non-regional departments in the Czech Republic. We found three cases of ureteroarterial fistula in the presented analysis that focused on urological toxicity of oncogynecological treatment. RESULTS: Within the mentioned period of ten years, we recorded 64 cases of urinary fistulas, and 47 patients (73.4%) were directly related to oncogynecological treatment. In the group with gynecological tumors, we found three patients (6.4%) with a diagnosis of ureteroarterial fistula, two of whom died directly related to this complication (exsanguination). These patients were treated for cervical cancer. All of them underwent radiotherapy during the treatment. CONCLUSION: Ureteroarterial fistulas are the most severe complications that can occur in medicine. This work confirms that we have encountered these cases even recently. Management is highly demanding for patients affected in this way and requires multidisciplinary cooperation. Endovascular intervention methods can control bleeding in emergency situations with non-surgical approaches. However, they are usually the first step towards a definitive surgical solution.
- Klíčová slova
- artery, fistula, hematuria, malignancy, ureter,
- MeSH
- cévní píštěle * etiologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- močové píštěle * etiologie MeSH
- nádory děložního čípku MeSH
- nádory ženských pohlavních orgánů radioterapie MeSH
- nemoci močovodu etiologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION AND HYPOTHESIS: Information on urethral bulking therapy in women after previous pelvic radiotherapy is lacking. This study compared the safety and efficacy of polyacrylamide intraurethral injections in patients with and without previous radiotherapy. METHODS: A total of 46 patients with severe stress urinary incontinence (SUI) were enrolled in this multicenter prospective trial. Group A consisted of 24 patients with previous radiotherapy to the pelvis for the treatment of a gynaecological malignancy. Group B consisted of 22 patients without previous radiotherapy. All patients were treated with a transurethral injection of a bulking solution (Bulkamid). The average follow-up was 12.4 months. The paired Wilcoxon test was used to compare the results before and after the procedure within the groups, and the two-sample Wilcoxon test was used for comparisons between groups. RESULTS: Complete continence was achieved in 25 % of patients in group A and in 36.4 % of patients in group B. Significantly reduced urine leakage was observed in both groups (p = 0.0164 in group A and p = 0.0002 in group B). The total scores in the International Consultation on Incontinence Questionnaire decreased by 5.2 in group A (p = 0.0000) and 6.36 in group B (p = 0.0001). The scores for the Total Patient Perception of Bladder Condition decreased by 1.54 in group A (p = 0.0001) and 2.59 in group B (p = 0.0000), with a significant difference between groups (p = 0.0224). No clinically significant changes in urodynamic parameters were observed. No severe adverse events were noted. CONCLUSIONS: Based on our results, we conclude that urethral bulking therapy is a valuable treatment option in patients with severe SUI who have undergone pelvic radiotherapy for the treatment of gynaecological malignancy.
- Klíčová slova
- Pelvic radiotherapy, Polyacrylamide hydrogel, Stress urinary incontinence, Urethral bulking,
- MeSH
- akrylové pryskyřice aplikace a dávkování škodlivé účinky MeSH
- biokompatibilní materiály aplikace a dávkování škodlivé účinky MeSH
- dospělí MeSH
- hydrogely aplikace a dávkování škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory ženských pohlavních orgánů komplikace radioterapie MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stresová inkontinence moči komplikace farmakoterapie patofyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky kontrolované MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Názvy látek
- akrylové pryskyřice MeSH
- biokompatibilní materiály MeSH
- Bulkamid MeSH Prohlížeč
- hydrogely MeSH
- polyacrylamide MeSH Prohlížeč
OBJECTIVE: A description of intensity modulated radiation therapy (IMRT) technique and its implementation in the treatment of gynecologic malignancies. SUBJECT: A review article. SETTING: Department of Oncology and Radiotherapy, University Hospital in Hradec Králové. SUBJECT AND METHOD: General explanation of IMRT priciples, its benefits and limitations, and a review of published data about its utilization in the treatment of endometrial, cervical, and vulvar carcinoma. CONCLUSION: IMRT represents an accessible and highly conformal external beam radiothrapy technique, which enables a significant sparing of healthy tissue with consequent reduction of radiation morbidity in comparison with other conventional and conformal techniques. A feasibilty of dose excalation with preservation of low toxicity is another advandage of IMRT. It can be utilized in the treatment of most frequent gynecologic tumors, especially in endometrial, cervical, and vulvar carcinoma.
The aim of this study was to assess the incidence and risk factors of pelvic fractures as a result of radiation therapy in women with gynecological cancer. We retrospectively reviewed 3530 female patients treated at our institute between 1980 and 1998 with megavoltage radiation with or without brachytherapy for cancer in the pelvic area. Eligible were patients with vulvar, vaginal, cervical, endometrial, and fallopian tube cancer. Median follow-up was 88 months (range 0-240). Emphasis was put on treatment-related and patient-related risk factors. Of the eligible 3155 patients, 15 developed symptomatic bone fracture caused by osteoradionecrosis, which makes an overall incidence of 0.44% The diagnosis was based on anamnesis, clinical course, and X-ray or computed tomography images. Median time of onset was 44 months (range 6-197). All patients had pain as the first symptom. The only independent predictive factor for developing osteoradionecrosis seemed to be preexistent osteoporosis. Other risk factors that are related to osteoporosis include higher age, postmenopausal status, or steroid treatment. We did not find any significant treatment-related predictive factor for pelvic osteoradionecrosis. Patients with osteoporosis are probably at the highest risk for developing osteoradionecrotic fractures after pelvic radiotherapy. More studies are needed to find out other endogenous predictive factors.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- fraktury kostí diagnostické zobrazování etiologie MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory ženských pohlavních orgánů radioterapie MeSH
- následné studie MeSH
- osteoradionekróza diagnostické zobrazování etiologie MeSH
- pánevní kosti diagnostické zobrazování účinky záření MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- močový měchýř účinky záření MeSH
- nádory ženských pohlavních orgánů radioterapie MeSH
- radioterapie škodlivé účinky MeSH
- urodynamika účinky záření MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- lidé MeSH
- nádory močového měchýře radioterapie MeSH
- nádory ženských pohlavních orgánů radioterapie MeSH
- nemoci střev etiologie chirurgie MeSH
- radiační poranění chirurgie MeSH
- radioterapie škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- angiografie * MeSH
- brachyterapie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory ženských pohlavních orgánů radioterapie MeSH
- pánev krevní zásobení MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- metody MeSH
- nádory ženských pohlavních orgánů farmakoterapie radioterapie MeSH
- senioři MeSH
- vitamin E aplikace a dávkování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- vitamin E MeSH
