The Immediate Effect of Abdominal Hysterectomy on Intravesical Pressure and Detrusor Activity

Abstract

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

The etiology of urinary retention after surgery for genuine stress incontinence

“…Current theories concerning the etiology of transient postoperative urinary retention include the effects of periurethral and perivesical edema [Seski and Diokno, 1977;Wake, 1980], inhibition of detrusor contractility [Seski and Diokno, 1977], failure of the external urethral sphincter to relax [Tammela et al, 1986a;Petros et al, 1993;Kaplan et al, 1997Gonullu et al, 1999, and outlet obstruction due to bladder neck elevation after surgery for stress urinary incontinence [Zimmern et al, 1987;Webster and Kreder, 1990].…”

Stress urinary incontinence: What, when, why, and then what?

“…[15] However, evidence neither supports avoidance of clinically indicated hysterectomy nor performance of supracervical hysterectomy as measures to prevent urinary incontinence. [2223]…”

Postoperative Voiding Dysfunction

“…The response rate was only 60-67% but no differences were found between these groups with respect to urinary symptoms other than the incidence of stress urinary incontinence, which actually decreased following total abdominal hysterectomy. Wake [35], Vervest et al [41] and Langer et al [39] have all shown a lack of clinically significant urodynamic changes or urinary incontinence following hysterectomy with studies that had each used prospective pre-and postoperative urodynamics. Demirci et al [46] used perineal ultrasound to assess the bladder neck before and one year after hysterectomy in 39 patients.…”

“…Since Hanley [33] reported voiding dysfunction as a late complication following hysterectomy there have been many studies that have approached this problem [34][35][36][37][38][39][40][41][42][43][44][45][46][47]. These studies are summarized in Table 46.2.…”

“…Urodynamic assessments were used in some studies, but sample sizes were usually small. [35,36,[39][40][41][42] Several studies are quite notable and have influenced some aspects of clinical practice [37].…”