[Extrinsic obstruction of the ureter in colorectal cancer--aspects of pathogenesis, diagnosis and treatment].

BACKGROUND: Primary or recurrent colorectal cancer (CRC) may lead to extrinsic obstruction of the ureter (EOU) necessitating differentiated and individual approach based on the genesis of the lesion. AIM: Analysis of the pathogenesis, risk factors, clinical presentation, diagnosis and treatment of cases of EUO in our experience. MATERIAL AND METHODS: From Jan., 2003 to Dec., 2005 21 patients with EUO were treated at the authors' institutions. The study was prospective and clinical, laboratory and instrumental data were collected and analyzed. The EUO's were classified as carcinomatous infiltration by the primary or recurrent tumor (Group A), post radiation therapy (Group B) and operative lesions (Group C). Cases of involvement of the ureter and urinary bladder as well as such of distant metastases were not included in the study. Methods of treatment consisted of resection and end-to-end uretero-ureterostomy or ureteroneocystostomy (11 cases), insertion of a double-J catheter (4 cases), nephrostomy (6 cases). RESULTS: The early postoperative mortality and morbidity rates were 0% and 28.57% respectively. Urinary infection was the most often specific complication. CONCLUSIONS: EUO remains a challenging complication of CRC. It is most often observed in patients between 51 and 60 years of age with recurrent rectal cancer stage III (Dukes C). Cases of group B and group C are indicated for radical ureteral resection and reconstruction while those of group A need just conservative measures for overcoming urinary stasis.