Analysis of urodynamic study selected parameters as evaluation of lower urinary tract dysfunction following a radical hysterectomy and radiotherapy because of cervical cancer

The aim of this study was to evaluate lower urinary tract dysfunction following a radical hysterectomy because of cervical cancer. Material and methods: We retrospectively selected and examined a population of 57 women treated in the Department of Operating Gynaecology of ICZMP in Lodz. There were 27 women suffering from cervical cancer (group I), and 30 women operated on for benign uterine diseases (group II). All patients underwent multi-channel urodynamic studies preoperatively and consequently 6 weeks, 6 months and one year after surgery. A sensation of filling during cystometry was evaluated by volume for first desire to void (FD/ml), normal desire to void (ND/ml) and volume for strong desire to void (SD/ml). In each patient cystometric bladder capacity (CBC/ml) and bladder compliance (C/ml/cm H2O) were also determined. Detrusor function was assessed by recording detrusor pressure during filling of the bladder. The presence of overactive detrusor with urge incontinence (UI) and voiding with abdominal strain were determined. Stress urinary incontinence (SUI) was diagnosed at the time of water cystometry if there was urinary loss associated with elevation of abdominal pressure during coughing. Mixed incontinence (MD) was diagnosed if criteria of stress as well as urge incontinence were fulfilled. Results: Dysfunctions of the filling phase of bladder among examined patients after RH present 6 weeks after operation and during the next follow-up visits were connected with sensation disruption of the bladder. The comparison of FD in groups I and II revealed one statistically significant discrepancy in average values 6 weeks after the operation (p<0.001). Another observed disturbance at this stage of urodynamic examination was decreased compliance of bladder walls in group I during three following estimations: 6 weeks, and 6 and 12 months after operation. Reduction of bladder compliance in populations subjected to operative treatment of cervical cancer was accompanied by a fall in bladder capacity. Uncontrolled contractions of detrusor muscle together with leakage of urine and obvious diagnosis of urge incontinence (UI) were noted 6 months after operation in 7 (26%) cases of group I. One year after operation there were 10 (37%) cases. The problem of urinary stress incontinence in this group was of similar frequency. SUI was preoperatively diagnosed only in 4 women from group I and in 6, 12 and 15 respectively 6 weeks and 6 and 12 months after operation. Conclusions: We can conclude that disorders of bladder function resulting from radical hysterectomy as a treatment for cervical cancer appear to be an important problem not only early after operation but long-term after as well. That is why in such patients precise uro-gynaecological analysis should be performed during the first years after operation.