Postradiation ureteral obstruction

The incidence of ureteral obstruction secondary to postradiation fibrosis is quite low. With today's modern radiation techniques, excessive parametrial fibrosis usually occurs only when there has been a gross overdose or faulty technique. Additive trauma to these tissues from such factors as infection or surgery can also lead to this problem. Laparotomy is almost invariably necessary to make a correct diagnosis. The treatment of choice at present is redirection of the obstructured ureter with maintenance of an intact urinary tract. Ureteroneocystotomy, Ockerblad flap ureteroneocystotomy, ureteroileoneocystotomy and transureteroureterostomy may all be considered. Ureteral dilation or simple freeing of the ureter from its fibrotic bed is not adequate therapy. Permanent urinary diversion should be reserved only for those cases where initial procedures have failed.