Voiding dysfunction after radical abdominal hysterectomy
Kuo, H.C.; Tsai, T.C.; Hsieh, C.Y.; Lee, C.J.
Journal of the Formosan Medical Association 84(10): 1137-1146
1985
ISSN/ISBN: 0371-7682 PMID: 3866830 Document Number: 250016
Preoperative and postoperative urodynamic studies were performed on 47 patients who underwent radical hysterectomy and bilateral lymphadenectomy due to cervical cancer to further assess the functional alternation of bladder and urethra at different stages. All patients developed hypertonic, poor compliant bladders and reduction in urethral closure pressure before bladder training was begun. After 3 to 6 months, 3 different types of cystometric change were noted. Twenty-five patients (53.2%) had hypotonic, large capacity and acontractile bladders while 15 (31.9%) had a better compliant, normal tonic but still difficult emptying bladder. The remaining 7 patients (14.9%) maintained the hypertonic state as the immediate postoperative change. Maximal urethral closure pressure reduction were noted in 29 patients (61.8%) at stage D, remaining unchanged in 13 (27.6%) and elevated in 5 (10.6%). Forty-three patients had a diminished or absent sensation of bladder fullness and all except one complained of dysuria. They had to void by the clock with the aid of abdomina pressure. Both intrinsic myogenic tonic change and complete or partial denervation of the autonomic system innervating bladder and urethra are considered to contribute to these results. Denervation test was done in 40 patients and 32 (80%) showed positive results. It should be emphasized that adequate postoperative bladder drainage to avoid overdistention and the myogenic change is as important as careful tissue dissection to provide less injury of nervous plexus. A rather high incidence of bladder dysfunction rate was discovered in this study. It seems necessary to further modify the intraoperative and postoperative managements to reduce the incidence of "bladder cripple".