Sacral Neuromodulation for Post-Hysterectomy Hydroureteronephrosis in a Patient with Cervical Cancer: A Case Report.

BACKGROUND Uterine cervical cancer in its early stage is managed with a standard treatment protocol of radical hysterectomy with bilateral pelvic lymphadenectomy. Common complications after the surgery include hydronephrosis, partially leading to renal failure. Currently, there are few reports on upper urinary tract function impairment caused by delayed lower urinary tract dysfunction after radical hysterectomy. Here, we present a case in which sacral neuromodulation (SNM) was successfully used to treat severe hydroureteronephrosis after radical hysterectomy for uterine cervical cancer. CASE REPORT A 44-year-old woman was diagnosed with bilateral hydroureteronephrosis and renal insufficiency (serum creatinine at 287 µmol/L) more than 1 year after undergoing radical hysterectomy for uterine cervical cancer. After utilizing an indwelling catheter for 3 months, her renal function showed a progressive improvement and stabilized at around 126 µmol/L. Videourodynamic study (VUDS) indicated decreased bladder compliance, bilateral ureteral reflux, with the reflux graded as IV-V. After confirmation that the upper urinary tract damage was caused by the elevated bladder pressure and not by invasion of the bladder by the primary tumor, SNM was performed to restore lower urinary tract function and to maintain low-pressure urine storage and micturition. Currently, 4 years after the surgery, the creatinine level has progressively declined to 75 µmol/L. Ultrasonography revealed no signs of hydronephrosis. Routine urine tests and post-void residual urine volumes are normal. CONCLUSIONS In select patients, sacral neuromodulation can protect the upper urinary tract, probably by improving lower urinary tract function.