Passive ileal segment urinary diversion in advanced cervical carcinoma--a retrospective review.

OBJECTIVES: Urinary diversion is a clinical management option that gynaecological oncologists often use for urinary fistulas associated with cervical cancer. We retrospectively reviewed the indications and postoperative morbidity and mortality associated with this procedure. METHODOLOGY: The case records of all patients with cervical carcinoma undergoing a passive ileal segment urinary diversion at King Edward VIII Hospital in Durban between 1 January 1991 and 31 December 1995 were reviewed retrospectively. The patient profile, indication for the operation and postoperative morbidity and mortality were noted. RESULTS: Sixty-five patients were entered into the study. Thirty-two patients (49%) had untreated advanced cervical carcinoma, 12 (19%) had had prior palliative irradiation for cervical carcinoma and 21 (32%) had received prior radical radiotherapy for cervical carcinoma. Fifty per cent of patients experienced significant postoperative morbidity. This was especially high in those patients who had received prior radical radiotherapy (67%). Twelve patients (19%) died before discharge. Six (50%) of those who had received prior radical radiotherapy died following the procedure. Advanced age (more than 65 years), previous radical radiotherapy, extrapelvic metastatic carcinoma and re-laparotomy for complications of the procedure were significant risk factors for postoperative mortality in our study. CONCLUSION: Careful patient selection, the use of bowel free of radiation injury, supportive management of postoperative complications and the establishment of a specific unit of trained staff are essential in order to ensure a successful outcome in patients undergoing this procedure.

Effect of misoprostol for cervical ripening prior to pregnancy interruption before twelve weeks of gestation.

BACKGROUND: Liberalization of the law in respect of legal abortions has led to a search for an appropriate technique for termination of pregnancy. The technique should be cheap, easy to perform and have minimal or no complications. AIM: To evaluate the effectiveness of performing manual vacuum aspiration (MVA) with and without the use of misoprostol to the procedure. DESIGN: Randomised control study. SETTING: Obstetrics and Gynaecology Department, University of Natal Medical School, South Africa. RESULTS: One hundred and thirty six women were recruited; 70 women were assigned to the misoprostol group. Of these, 11 (15%) did not show any change in cervical score. Their mean cervical dilatation was similar to the control group (3.3 versus 31; p > 0.06). In the group whose gestational age was less than eight weeks, the time taken to complete the procedure, quantity of products of conception and cervical dilatation, were different from that of the control group, and this reached statistical significance except quantity of products of conception in primigravidae. In pregnancies greater than eight weeks gestation, all parameters assessed, such as cervical dilatation, quantity of products of conception was significantly different from the control group, in both multi- and primigravidae. Pain score was similar for all gestations. CONCLUSION: Misoprostol is of specific value during MVA for voluntary interruption of pregnancy.