title: Renal ultrasound to detect hydronephrosis: a need for routine imaging after radical hysterectomy?
abstract: BACKGROUND
  Hydronephrosis can be a side effect of radical hysterectomy for cervical cancer. The incidence of clinically relevant hydronephrosis has not been studied in a large sample and the benefit of early detection of hydronephrosis is not clear.
  
  
  OBJECTIVE
  To assess the incidence of hydronephrosis, following radical hysterectomy and evaluate the usefulness of routine renal ultrasound (RH).
  
  
  METHODS
  Retrospective study, January 1998 and December 2008. Cervical cancer patients (FIGO stage IBI-IIA), treated with radical hysterectomy and pelvic lymph node dissection with or without adjuvant radiotherapy, without surgical lesion of the ureter, followed-up 6 months in the Academic Medical Center Amsterdam. Routine renal ultrasound was performed four weeks after RH, and in some on indication before or after the routine ultrasound. We documented which interventions for hydronephrosis were performed and evaluated the profile of patients at risk for hydronephrosis.
  
  
  RESULTS
  281 patients were included: 252 (90%) underwent routine renal ultrasound and 29 (10%) underwent imaging on indication before routine ultrasound. The overall incidence of hydronephrosis was 12%. In symptomatic patients, the incidence was 21% and 9% in asymptomatic women undergoing routine ultrasound. Four patients were invasively treated for hydronephrosis (1% of the total group) after imaging for clinical suspicion of hydronephrosis. Patients with hydronephrosis were significantly more often treated with radiotherapy than patients without (43% versus 25% (p=0.03).
  
  
  CONCLUSIONS
  There is no place for routine renal ultrasound following radical hysterectomy. Patients should be instructed about the symptoms that may be related to hydronephrosis, to allow for renal ultrasound on indication.
authors: Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands. m.h.hazewinkel@amc.uva.nl
authors: Menke H
authors: MH
authors: Hazewinkel
authors: Lieke
authors: L
authors: Gietelink
authors: Jacobus
authors: J
authors: van der Velden
authors: Matthé P M
authors: MP
authors: Burger
authors: Jaap
authors: J
authors: Stoker
authors: Jan-Paul W R
authors: JP
authors: Roovers
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D007044:Hysterectomy / Q000009:adverse effects; D007668:Kidney / Q000000981:diagnostic imaging*; D008197:Lymph Node Excision / Q000009:adverse effects; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014463:Ultrasonography; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*