18 Postoperative urological complications after radical surgery for cervical cancer

Abstract

Functional disorders of the lower urinary tract must be considered inevitable after Wertheim hysterectomy. These disorders include disturbances of the collecting phase as well as of the voiding phase of the bladder, and the development of urinary stress-incontinence. Urodynamic studies are necessary to find out more about the pathophysiology of these disorders. The results of our follow-up studies confirm that during the early postoperative phase patients do not feel the urge to void, and, after micturition, have no idea whether or not the bladder is empty. Micturition itself becomes difficult. At a later stage, sensitivity in respect of the bladder contents is regained. Some months later the incidence of urinary stress-incontinence rises markedly. The dysfunction is due partly to direct trauma of the bladder and urethra. As a reason for the long-lasting fall in urethral closure pressure, combined with urinary stress-incontinence, some damage to the pelvic nerves must be assumed. Disorders of micturition have been poorly investigated. It is only during the postoperative phase that functional infravesical obstruction must be assumed. At a later stage micturition mostly becomes normal. In contrast to the results of others (Schüssler, 1988) the results of our studies confirm that these disorders are due not only to nerve lesions. Disorders of the collecting phase as well as of the voiding phase of the bladder are mostly transient. As a consequence we suggest that the direct operative trauma, with oedema, haematoma and scar formation, is responsible for bladder dysfunctions during the early postoperative stage at least.(ABSTRACT TRUNCATED AT 250 WORDS)