Stress urinary incontinence following radical hysterectomy with and without radiation therapy: Surgical results in 13 patients

Only a few articles have reported clinical experience of treating patients with stress urinary incontinence following radical hysterectomy and postoperative irradiation. These cases are generally characterized by detrusor areflexia, small bladder capacity, and low bladder compliance. During the past 5 years, 13 such patients were operated upon, including 6 patients without irradiation. Of these 8 had the Stamey procedure, 3 had a vaginal wall sling, and 2 had a pubovaginal sling. The success rate was 71% for the group with irradiation and 100% for the group without irradiation, while the overall success rate was 85%. Surgery significantly improved two anatomic parameters in a chain cystourethrogram: the posterior urethrovesical angle and the conjugata incontinentia. Surgical indications relevant to successful outcome are discussed.Supported partly be a research grant for aging from the Japanese Ministry of Health and Welfare.Editorial Comment: Little is known regarding the therapy of genuine stress incontinence following radical hysterectomy, especially when associated with radiation therapy. The surgeon is faced with potentially severely altered urethrovesical function due to the decentralization of the lower urinary tract secondary to the radical surgery. Non-compliant low capacity bladders make therapy of stress incontinence difficult. When radiation therapy is added marked alterations in tissue plasticity and blood supply result. The combination of all these factors complicate the medical and surgical therapy of incontience, and frequently the surgeon decides not to operate because of the increased possibility of failure. Although the numbers are small this paper demonstrates that good success rates for surgical therapy of genuine stress incontinence is possible when the proper surgical procedure is chosen.