Vesical Exclusion in the Treatment of Carcinoma of the Cervix Uteri

in an upward and outward direction. Anterior extension involves the bladder base and causes malignant ulceration of the bladder. A severe cystitis leads to vesico-vaginal fistula, ascending infection, pyelo-nephritis and death. Extension in an upward and outward direction in the broad ligament leads to encroachment on the ureter, which may become infiltrated by malignant tissue. Following obstruction in the ureter there is dilatation of the upper urinary tract hydro-nephrosis and hydro-ureter. Occlusion of the ureter brings about cessation of urinary excretion from that kidney, and, if bilateral ureteral occlusion occurs, there can only be complete post-renal anuria. The degree of dilatation reached in the upper urinary passages varies inversely with the rapidity of development of the obstruction. Since the potential of both kidneys is normally far in excess of that required to maintain renal efficiency, a considerable degree of damage from backward pressure may be borne by the renal parenchyma before any clinical evidence is available