Abnormal urodynamic findings after radical hysterectomy or pelvic irradiation for cervical cancer

Abstract

Objective: To assess urodynamic study results in patients with cervical cancer who had received radical hysterectomy or pelvic irradiation or radical hysterectomy with pelvic irradiation. Methods: Forty-two patients with stage IB cervical cancer after radical hysterectomy (group A), 11 patients at stage IB or IIA after pelvic irradiation (group B), 15 patients at stage IB or IIA after both radical hysterectomy and pelvic irradiation (group C) and 17 patients at stage IB before treatment (group D) as control were recruited for urodynamic examination. The evaluations for each case included a 20-min pad test, uroflowmetry, both filling and voiding cystometry, and stress urethral pressure profile. ANOVA method with Bonferroni test and Pearson χ2-test were utilized for statistical analysis. Results: The mean ages in sequential groups A, B, C and D were 52.9±10.2, 62.5±13.5, 49.8±11.7 and 49.4±12.5 years (P=0.02), respectively. The occurring frequency of either detrusor instability or low bladder compliance was 57%, 45%, 80% and 24%, respectively. Each group revealed decreased bladder capacity as 268.4±102.8, 164.1±62.9, 233.5±73.9 and 293.0±47.2 ml (P<0.0001). However, the frequency of abdominal strain voiding was 100% in groups A, B and C as compared to 0% in group D (P<0.01), and the frequency of abnormal residual urine (>50 ml) was 41%, 27%, 40% and 24%. Although each case showed a poor pressure transmission ratio (<100%), the frequency of positive pad test in each group was 81%, 46%, 100% and 18% (P<0.001). The functional urethral length decreased in each group and was 2.6±0.8, 2.3±0.8, 2.5±0.8 and 2.9±0.6 cm, but there were no significant differences in maximal urethral pressure or urethral closure pressure among the four groups. Conclusions: Our data show that abnormal urodynamic findings pre-exist in patients with cervical cancer before treatment especially in bladder storing function, and that these findings may worsen, or that new abnormal findings may happen after radical hysterectomy or pelvic irradiation, or both.