Bladder Dysfunction after Radical Abdominal Hysterectomy

Lee, Eun Sik; Kim, Si Whang

Abstract

Bladder dysfunction is a common occurrence following radical hysterectomy. It is a direct consequence of the intraoperative disruption of the autonomic nerve supply to the bladder. We herein evaluated 158 patients who underwent radical hysterectomy for carcinoma of cervix in the Dept. of Obstet.-Gynecol., Seoul National University Hospital into two separate part. In Part 1,140 patients who received the surgery from Jan. 1980 to Dec 1981 were subjected to this study. The records and the follow-up results were analysed retrospectively. Immediate postoperatively, 44.7% of patients presented bladder dysfunction such as large residual urine over 100 cc and delayed perception of bladder filling sensation. In 6 month follow-up group, 15.8% of patients complained urologic symptoms such as strain. stress incontinence, urgency and sensory loss. In 1 year follow-up group, the same symptoms were persisted in 11.5% of patients. In Part 2, urodynamic test was performed in 10 patients preoperatively and 18 patients postoperatively. No differences were found between two groups except marked increase of bladder volume at the first voiding sensation. Urecholine denervation test of Lapides was done in 18 patients postoperatively and three patients revealed positive test, which means partial parasympathetic detrusor denervation. To decrease the incidence of bladder dysfunction, the use of suprapubic cystostomy, subcutaneous injection of urecholine, intermittent self catheterization are recommended rather than indwelling urethral catheter. Urodynamic test is necessary to define the nature and to manage the patients with bladder dysfunction after radical hysterectomy.