Prospective Urodynamic Study of Bladder Dysfunction after Radical Abdominal Hysterectomy

Choi, Seong; Son, Eun Ho; Rhew, Hyun Yul; Kim, Dong Hwi

Abstract

The present study comprehensively evaluated lower urinary tract function prospectively using urodynamic study to delineate and quantify changes that take place in the lower urinary tract subsequent to radical abdominal hysterectomy. This report is follow-up investigation of 36 women treated for cervical carcinoma FIGO stages Ib (27), IIa (5) and IIb (4) from January, 1995, to March, 1996 at the Department of Gynecology, All patients were operated on by the same surgeon. The mean age of the study patients was 46 years with ages ranging from 31 to 60. The mean follow up period was 9 months (2-14 month). The urodynamic study was obtained using a Jupiter-8000 F/M Wiest. A 12Fr. three-way catheter (Porges) was placed on the bladder, and a 22Fr. rectal manometry balloon catheter was located 10cm from the anus in the supine position. Normal saline was infused continuously into the bladder through a three-way catheter with a infusion pump at a medium rate of 30ml per minute. Urethral pressure profiles were recorded with the same 12Fr. three-way catheter during withdrawal of catheter in a stepwise fashion (l mm/sec), and then uroflowmetry was recorded during voiding in the sitting position. Compared with preoperative status, in postoperative 3rd week and postoperative 6ih week, changes of following parameters were statistically significant: 1) average flow rate decreased, 2) residual urine volume increased. 3) bladder capacity and 4) detrusor pressure decreased in postoperative 3rd week (.p<0.05). Voiding volume, bladder compliance, maximal urethral pressure and functional urethral pressure were also decreased, but those were not statistically significant. We have obtained a functional recovery of the urodynamic parameters at about 6 weeks after operation. The voiding dysfunction developed in 4 cases (9%) after postoperative 6th week. The urodynamic classification of lower urinary tract dysfunction (1988, ICS) showed 2 in normal/normal, 1 in underactivity/normal and 1 underactivity/hyposensitivity. In conclusion, postoperative voiding dysfunction after cervical carcinoma operation, where urologic care is necessary, is considered to be a temporary change.