Neurourological changes before and after radical hysterectomy in patients with cervical cancer

Abstract

Background. The severity of bladder dysfunction in patients receiving radical hysterectomy for cervical cancer has been related to the delicacy and the degree of radicality of the hysterectomy. Our goal was to evaluate the effect of modified radical hysterectomy on the storage and evacuation of the lower urinary tract. Methods. In this prospective study, 18 patients underwent radical hysterectomy for cervical cancer with FIGO stages Ia, Ib and IIa. These patients participated in a pudendal motor nerve conduction study and a urodynamic study, including urethral pressure profile (UPP), cystometry (CMG) and uroflowmetry (UFR). These were carried out at preoperative baseline and at 2 weeks, 6 weeks, 3 months and 6 months following surgery. We used generalized linear models to evaluate, over time, the relationship between the different parameters marked in these profiles. Results. The average pudendal nerve motor latency was prolonged at 2 and 6 weeks after surgery but recovered to baseline at 3 months postsurgery. Maximal urethral closing pressure revealed a tendency to decrease, and the CMG showed a significant increase in maximum intravesical filling pressure and a marked decrease in compliance throughout the investigative course. Increased residual urine volume and decreased uroflow rates were detected in a series of UFR. However, these values headed for baseline at 6 months after surgery. Conclusion. Transient neurological changes in the majority of our patients suggested that both somatic and autonomic demyelination with or without denervation might be responsible for the temporal changes in vesicourethral function after radical hysterectomy and recovery to baseline condition within 6 months.