Effect of hydronephrosis on survival in advanced stage cervical cancer.

BACKGROUND: Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. MATERIALS AND METHODS: The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. RESULTS: The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (p<0.05). There was no significant survival difference between patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (p<0.05). CONCLUSIONS: Hydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presence or absence of hydronephrosis.

Perioperative and postoperative complications after Ophira mini sling operations.

AIM: To evaluate perioperative and postoperative complications of mini sling operations in the surgical treatment of female urinary incontinence. METHODS: The study was comprised of 151 female patients with stress urinary incontinence (SUI) or mixed incontinence (MUI) with predominant SUI patients who underwent the mini sling procedure. The duration of the follow-up ranged from 6 to 21 months. All women had positive cough stress tests preoperatively. The procedure was performed under local (86.1 %) or spinal anesthesia (13.9 %) with the same mini slings for all cases. Patients were examined in the outpatient clinic at 1 and 6 months after surgery. RESULTS: The mean age was 49 years old (SD 10) with a range of 26-82. Of the 151 patients, 42 (27.8 %) presented MUI, while 109 (72.2 %) presented SUI. Mean parity was 3 ± 1. Mean body mass index was 28.9 ± 3.5. 60 (39.7 %) of the cases were postmenopausal. There were 73 women who participated in 6 months follow-ups and 78 women who did 1-year follow-ups. The mean operating time was 13 ± 3.1 min. There were no major intraoperative complications due to mini sling surgery. 120 (79.5 %) patients were discharged the day following the surgery. Ten patients (6.1 %) had de novo urge incontinence in their post-operative follow-ups which was resolved using anti-cholinergic drugs. Two patients (1.2 %) required sling sections due to prolonged bladder outlet obstruction. There were 15 patients that complained about de novo dyspareunia (9.9 %). Vaginal mesh extrusion was reported in 18 (11.9 %) patients. The mean preoperative and postoperative hemoglobin concentrations were 12.9 ± 1.3 and 12.5 ± 1.3 g/dL, respectively. CONCLUSION: The mini sling system can be considered an easy and effective method for treating stress urinary incontinence without major complication rates.