[Pathology of the gynecologic ureter: our experience]. / Patologia dell'uretere ginecologico: nostra esperienza.

UNLABELLED: Endometriosis, surgery and radiotherapy are the main causes of ureteral injuries in gynaecologic pathology. MATERIALS AND METHODS: In this paper we present our experience about ureteral injuries. We treated 31 patients; 6 cases of endometriosis, 13 cases of pelvic radiotherapy for gynecologic tumors, 12 cases of ureteral injuries after gynecologic surgery. The treatments were different depending on the cause of the lesion and on the site of the lesion. In 3 cases we performed an ureteral-bladder implant with bladder psoas hitch, in 2 cases an end to end anastomosis was made. In 2 cases we made an ureteric substitution with Boari bladder flap. In 8 cases the ureteral stenting with DJ or a percutaneous nephrostomy was the solution. RESULTS AND CONCLUSIONS: In our experience good results can be obtained with ureteral implant and bladder psoas hitch. The end to end ureteral anastomosis had disappointing results in our hands. In case of ureteral fistula it would be better repair it as soon as possible. If the ureteral lesion is recognised during surgery and the loss of substance is not complete, the suture on stent can be performed.

[Complications of urinary diversion after radiotherapy]. / Complications of urinary diversion after radiotherapy.

Primary radiation therapy may be recommended for patients with invasive bladder cancer, gynecological or prostatic cancer. When complications occur or in case of malignant recurrence, urinary diversion may be the best chance to restore an acceptable quality of life. The complication rate after this surgery is doubled. We report our experience in 32 patients submitted to urinary diversion after radiotherapy from 1985 to 2000: 2 enteric fistulas; 2 urinary fistulas; 5 stenosis of uretero-intestinal anastomosis were our complications. Radical cystectomy (24 cases) or anterior pelvic exenteration (8 females) preceded urinary diversion. Preoperative high-dose radiotherapy contributes to increased postoperative morbidity rates, particularly entero-enteric fistulas, uro-intestinal fistulas and stenosis of the uretero-intestinal anastomosis. In our experience, in most of the major urinary or enteric complications non surgical management was inefficient and surgical management was necessary.

Pubo-vaginal sling.

The Authors discuss their experience in the use of pubo-vaginal sling in the treatment of female urinary stress incontinence. In the last 5 years (1997-2002) 35 patients with type 3 incontinence underwent pubo-vaginal sling with rectus fascia or porcine skin. Healing was obtained in 74.2%, de novo urgency in 5.7%, obstruction in 8.5% and persisting incontinence in 11.4% of cases. The developments of the technique have recently turned pubo-vaginal sling into a minimally invasive procedure with low morbidity. Its indications have therefore been extended to the point that it is now considered by many authors as the treatment of choice in any type of incontinence, whether associated with genital prolapse or not.

Interstitial cystitis.

Interstitial cystitis (IC) is still considered a rare disease, but in the future its incidence will probably be revised if tendency is that of considering interstitial cystitis on the basis of clinical rather than endoscopic-histological criteria. According to some urologists, cystodistension and vesical biopsy, even if not pathognomonic, are still effective up till now, at least for their prognostic-therapeutic value as well. If on one hand in the diagnosis of this condition symptoms tend to be of more and more value unlike instrumental investigations, on the other hand little has changed in therapy.