To the Editor.—Advanced carcinoma of the cervix uteri is often manifested by obstruction of the distal portion of one or both ureters.1 However, proximal obstruction of the ureter from metastatic carcinoma of the cervix is most infrequent. Recently, a patient was encountered with postirradiation recurrent carcinoma of the cervix manifested by bilateral obstruction of both ureters at the ureteropelvic juncture.
Report of a Case
A 41-year-old woman was hospitalized with uremia and bleeding from a rectovaginal fistula 2½ years after radiation treatment for a stage III carcinoma of the cervix uteri. Biopsies of the rectovaginal fistula showed no tumor. Retrograde pyelograms demonstrated bilateral hydronephrosis from marked narrowing of the proximal 3 cm of each ureter. There was no evidence of obstruction to the distal portion of either ureter. A celiotomy was performed to divert the fecal stream and ascertain the cause of the ureteral obstructions. The upper one