Urinary Tract Dysfunction after Radical Hysterectomy for Cervical Cancer

Chen, Gin‐Den; Lin, Long-Yau; Wang, Po-Hui; Lee, Hong-Shen

doi:10.1006/gyno.2002.6614

Cited by 85 publications

(57 citation statements)

References 18 publications

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“…Because radical hysterectomy involves dividing and disrupting the cardinal and uterosacral ligaments, which contain the autonomic nerves from the pelvic plexus, bladder dysfunction may sometimes ensue. However, there is uncertainty about the role of radical hysterectomy on the onset of bowel dysfunctions [3,4,5,6,7,8,9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Bowel Dysfunction following Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Prospective Study

et al. 2014

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Objective: To objectively assess anorectal dysfunction following nerve-sparing radical hysterectomy in stage I-II cervical carcinoma patients. Material and Methods: Between 2008 and 2012, 21 patients with primary cervical cancer stage FIGO I-II were enrolled in this prospective study. All women underwent nerve-sparing radical hysterectomy. Anorectal manometry was performed preoperatively and 6 months after surgery. A paired Student t test was used to assess the statistical difference between the manometric evaluations. A p value <0.05 was considered statistically significant. Results: Twenty-one patients were available for follow-up. Maximal and mean anal resting and squeezing pressures were unaffected by the surgical procedure, rectoanal inhibitory reflex and length of the high anal pressure zone did not change after the operation. The minimal volume to elicit rectal sensation, urge to defecate and maximal tolerable volume did not change significantly in the postoperative period, although they decreased in 2 and increased in 3 patients. In addition, rectal compliance did not change after surgery. Furthermore, no significant differences were found between patients who were or were not treated with adjuvant radiotherapy. Conclusions: Our findings suggest that nerve-sparing radical hysterectomy for cervical cancer does not seem to be associated with long-term anorectal dysfunction.

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Section: Introductionmentioning

confidence: 99%

Bowel Dysfunction following Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Prospective Study

et al. 2014

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“…Although lower urinary tract dysfunction may improve with time after radical hysterectomy, some of the patients may have persistent symptoms of diffi cult urination and incomplete emptying for a long period [1,4,6] . Medication to relieve bladder neck dysfunction and external sphincter tone may be helpful, but side effects such as dizziness, fatigue, headache, and postural hypotension may preclude their use in the elderly, especially in those on other antihypertensive medications.…”

Section: Discussionmentioning

confidence: 99%

“…The urethral function after radical hysterectomy is characterized by non-relaxation of the external sphincter during abdominal straining to void, acting as an isolated urethral obstruction during voiding [4,6,9] . This bladder and urethral dysfunction may lead to diffi cult urination and result in a low fl ow rate and large post-void residual volume.…”

Section: Discussionmentioning

confidence: 99%

“…Because the urethral sphincter maintains a constant resistance, after radical hysterectomy patients must void by abdominal straining which results in isolated urethral sphincter obstruction [6] . The voiding dysfunction after radical hysterectomy is characterized by straining to void without detrusor contraction and a nonrelaxing urethral sphincter which results in diffi culty in urination, a large amount of post-void residual, and recurrent urinary tract infection [4,6] . Although clean intermittent self-catheterization (CISC) has been widely used to manage this lower urinary tract dysfunction, urinary tract infection or upper tract deterioration might occur and result in urological complications.…”

Section: Kuomentioning

confidence: 99%

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Effectiveness of Urethral Injection of Botulinum A Toxin in the Treatment of Voiding Dysfunction after Radical Hysterectomy

Kuo

2005

Urol Int

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Objective: After radical hysterectomy for cervical cancer patients may have difficulty in urination due to detrusor underactivity and a non-relaxing urethral sphincter. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating voiding dysfunction in these patients. Methods: Thirty patients with difficult urination after radical hysterectomy due to cervical cancer were enrolled to receive urethral injection of 100 units of botulinum A toxin (n = 20) or medical treatment as controls (n = 10). The clinical results and urodynamic parameters at baseline and after treatment were compared in the study group, and the quality of life (QOL) index was compared between the study and control groups. Results: After urethral injection of botulinum A toxin, 8 patients had excellent results (40%) and 8 had improved results (40%) in the study group. Both voiding pressure (115.2 ± 63.7 vs. 90.2 ± 49.5 ml, p = 0.025) and post-void residual volume (330.9 ± 124.9 vs. 183.9 ± 183.4 ml, p = 0.011) improved significantly after treatment. The obstructive symptom score was significantly reduced (17.5 ± 4.7 vs. 5.7 ± 2.3 points, p = 0.000) and the QOL index also improved (4.5 ± 2.7 vs. 2.3 ± 2.3 points, p = 0.000) after treatment. The success rate was 80% in the study group. There were no significant changes in obstructive symptom scores or the QOL index in the control group. The maximal effect appeared about 1 week after treatment. The duration of the therapeutic effect ranged from 3 to 9 months. Mild stress urinary incontinence and nocturnal enuresis were noted in 7 patients (35%). Conclusion: Urethral injection of botulinum A toxin can be effectively used to treat patients with detrusor underactivity and non-relaxing urethral sphincter after radical hysterectomy with few adverse effects.

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“…Symptoms emerge due to invasion or involvement of the urinary system, compression of the mass, or treatment of a pathologic condition [1]. Although urinary dysfunctions may develop secondary to malignancy, they frequently occur due to surgery and/or radiation therapy (RT) for the treatment of gynecologic cancer [2][3][4]. Urinary incontinence (UI) is the most important lower urinary system dysfunction caused by gynecologic cancer treatments.…”

Section: Introductionmentioning

confidence: 99%

Urodynamic assessment of short-term effects of pelvic radiotherapy on bladder function in patients with gynecologic cancers

Emirdar

Naykı²,

Ertaş³

et al. 2016

Ginekol Pol

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Objectives: To determine the short-term effects of adjuvant or primary curative radiotherapy (RT) on the urinary system in women with gynecologic cancer. Material and methods:This is a prospective, concurrent cohort study including 55 patients with gynecologic cancer who were divided into three groups. Group 1 included 10 patients who were administered adjuvant RT following a radical hysterectomy (RH); Group 2 included 36 patients who were administered adjuvant RT following a type 1 hysterectomy and Group 3 included 9 patients who were administered primary curative RT. Urogynecologic assessments were carried out on patients before and six months after the treatment.Results: Compared to pretreatment, no significant differences were observed in any of the three groups after treatment in terms of incontinence, first urge to urinate, normal urge to urinate, severe urge to urinate and changes in residual urine volumes. There was a significant decrease in maximal vesical pressure after treatment in Group 1 and Group 3. The maximum detrusor pressure decreased significantly in Group 1. The post-treatment decline in bladder capacity in Group 1 and Group 2 was also significant. Conclusions:RH and pelvic RT cause lower urinary system dysfunction. Especially patients who receive primary curative RT and patients who are administered RT after RH, where more pelvic denervation occurs, are at higher risk due to high doses of RT.

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Urinary Tract Dysfunction after Radical Hysterectomy for Cervical Cancer

Cited by 85 publications

References 18 publications

Bowel Dysfunction following Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Prospective Study

Bowel Dysfunction following Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Prospective Study

Effectiveness of Urethral Injection of Botulinum A Toxin in the Treatment of Voiding Dysfunction after Radical Hysterectomy

Urodynamic assessment of short-term effects of pelvic radiotherapy on bladder function in patients with gynecologic cancers

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