Lower Urinary Tract Dysfunction as Persistent Complication of Radical Hysterectomy

Abstract

Background: This study was performed to evaluate late effects on the lower urinary tract after radical hysterectomy. Methods: We studied 9 women treated with radical hysterectomy for cervical cancer. All patients underwent surgery more than 10 years ago (range, 14 to 36 years). Six patients had urologic complications associated with lower urinary tract dysfunction. The remaining 3 were referred for urinary tract abnormalities detected by radiologic examinations. Lower urinary tract function was evaluated with thorough history taking, laboratory examinations, intravenous urography, and conventional urodynamic studies. Results: Obstructive voiding symptoms and/or urinary incontinence were observed in 7 patients. Uroflowmetry, which was assessable in 7 patients, revealed intermittent flow and a significant amount of residual urine in all patients. Cystometry revealed impaired bladder sensation, detrusor areflexia, straining on voiding, and probable impaired relaxation of the sphincter in all assessable patients. In addition, decreased bladder compliance was observed in 5 patients. Conclusion: All of the examined patients had severe and complicated urinary tract dysfunctions, even at more than 10 years after surgery. Careful follow-up may be mandatory for patients after radical hysterectomy, because compensating factors tend to mask their urologic symptoms.