This study was undertaken to determine the effect of simple abdominal hysterectomy on bladder function in the first postoperative week. It was found that initially there was a significant reduction in voluntary capacity, a rise in residual volume and an increase in intravesical pressure but that this was returning to normal after one week. The degree to which these changes occurred did not seem to be related to postoperative disturbances of micturition. DIFFICULTY in establishing normal micturition after pelvic surgery is not uncommon. It has been shown that radical hysterectomy produces temporary alteration in bladder function. The purpose of this study was to see if a similar effect was produced by simple abdominal hysterectomy and if so whether it was related to abnormalities of micturition in the first few days after operation. PATIENTS AND METHODPatients admitted for uncomplicated abdominal hysterectomy were selected for study. It was proposed to assess bladder function by cystometry before operation and again on the third and seventh postoperative days. Twenty-seven patients entered the study, having given informed consent. Before operation a full urological history was taken, a midstream specimen of urine obtained, the residual volume measured and cystometry carried out.For cystometry, the bladder was filled through a two channel 10 Charriere catheter with sterile water at body temperature at a rate of 100 ml/ minute. lntravesical pressure was measured by connecting the efferent channel of the catheter to a pressure transducer and rectal pressure was recorded from an air filled balloon connected to a similar transducer. The pressure recordings were displayed on a two channel pen recorder and the apparatus was calibrated before and after each cystometry. During each cystometry I measured: (i) the residual volume; (ii) the volume which produced the first desire to micturate; (iii) the stage at which the patient felt the instillation of more water would produce severe discomfort (the voluntary capacity); and (iv) the rise in intravesical pressure at voluntary capacity.Of the 27 patients investigated, two had an abnormal urological history and cystometric evidence of detrusor instability and were excluded from the trial. Table I shows the mean value for each measurement on each occasion. The difference in the value for the third postoperative day and the preoperative value were calculated for each patient and from these differences the standard deviation, the t value and the probability factors using the Student's t test were calculated. The same calculation was carried out on the differences between the seventh and third postoperative day values. The results, shown in Table I, were statistically highly significant. RESULTSThus, after hysterectomy, there was a rise in the residual volume, a decrease in the volume 90 1

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‘Planning coffee breaks is one thing, getting them can be quite another’ – Charlotte Wake asks if we can take a team approach to caring for our mental health

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