Therapy for urologic complications secondary to irradiation of gynecologic malignancies

Hemorrhagic cystitis, ureteral stenosis or obstruction, and bladder fistulas are the most serious urologic complications secondary to pelvic irradiation for gynecologic malignancies. Hemorrhagic cystitis is usually controlled by formalin instillation. In instances of ureteral stenosis or obstruction or bladder fistulas, the possibility of tumor recurrence must be eliminated. Most patients with ureteral stenosis or obstruction will require surgical correction. Most patients with bladder fistulas will be best served by creation of an ileal conduit. In selected patients, closure of the fistula with pedicle flaps will be possible.