The urological complications after radical hysterectomy are more extensively described.
The denervated bladder i.e. the autonomous bladder and its consequent complications,
the hydroureter and hydronephrosis,
the ascending pyelonephritis,
the vesicovaginal fistulae,
the ureteral fistulae
prove, that radical hysterectomy represents an important intervention into the integrity of the remaining pelvic organs.
As regards the indication for radical hysterectomy in carcinoma of the cervix, it must be emphasised, that overtherapy has to be avoided by all means. The same recommendation must be made for the endometrial carcinoma, as we have demonstrated in a previous paper.
For stage Ia (5 mm limit) in the feature of an early stromal invasion, and advanced bulky outgrowth or a beginning network-like infiltration, a simple total hysterectomy, if necessary combined with outer iliacal and obturatory lymphonodectomy, has proved to be sufficient.
A pronounced net-like infiltration is to be ranged to stage Ib and ought to be subjected to radical hysterectomy. Here the infiltration limited to 5 mm is an illusion.
Primary urinary infections and dilatations of the upper urinary tract ought to be a reason to reconsider an already established indication for extensive surgery. After preliminary complete radiotherapy, the question of a primary ureteroneocystostomy or even pelvic evisceration ought to be discussed.
The abdominal radical hysterectomy has been described in a previous paper. The following remarks have to be added:
the resection of the vaginal web and the vagina ought not to be more radical than absolutely necessary, particularly if vaginal radium application follows, as the denervation of the bladder is directly dependant on the extension of the web's resection (Lewington),
the „Bindegewebsblatt“ of the ureter (Amreich) described by Sampson in 1904 as the “ureteral sheath” has to be spared,
a post-surgical bladder drainage of at least 3 weeks is indicated.
The first intravenous urogram ought not to be performed later than 6 weeks after the intervention and before a planned postoperative radiotherapy.
Urinary infections have to be energetically treated. Before the amount of residual urine is less than 50 ml post-operative irradiation is contraindicated.
Finally, after more than 40 years of experience in the treatment of carcinoma colli and as I am no longer personally concerned, I would like to draw the attention to the following postulate:
The carcinoma colli ought to be exclusively treated and controlled in great gynecological centers with corresponding specialized staff and equipment.