The late effect of hysterectomy with or without postoperative radiotherapy on bladder dysfunction in patients with uterine cancer

A serial urodynamic study was performed in 491 patients with uterine cancer following radical hysterectomy (RH) involving postoperative pelvic radiation (RH+RT) and extended hysterectomy (EH) for 10 years after these respective treatments. The following evidence is presented: (1) increased volume of residual urine and sensory impairment occurred 1–2 months after radical hysterectomy with or without radiation, but was rarely seen in the EH group: (2) increased residual urine volume in the RH group gradually subsided 1–3 years after the treatment, while the RH+RT treatment resulted in a slight reduction: (3) late maximum cytometric capacity in the EH and RH groups remained stable throughout the study, but the RH+RT group showed a lower capacity (P<0.05) than the EH group, except in one set of determinations. (4) a high incidence of low bladder compliance in the RH group at 1–2 months decreased thereafter, whereas in the RH+RT group bladder compliance remained poor (23%) up to 7–10 years after treatment. In the EH group low bladder compliance was rarely seen: (5) sensory impairment, urinary incontinence and difficulty on urination remained unimproved in many patients in the RH+RT group, while the incidence of subsequent urological operations in the EH group was lower (P<0.05) than in the RH+RT group. Based on these findings, EH appears to be more beneficial for the retention of normal bladder function and radical hysterectomy with postoperative radiation results in deterioration of bladder activity.Editorial comment: We are gradually learning more about the effects of both radical hysterectomy and radiation therapy on urethrovesical function. It has been fairly well established that radical hysterectomy has variable effects on bladder function. However, less radical procedures have been less well studied and predictably would have a lesser effect than the more radical procedures, as is shown by this study. In addition, the effects of radiation therapy would be expected to be additive to the effects of whatever surgery was performed, with emphasis on the causation of detrusor malfunction, especially a decrease in capacity and compliance. This has been borne out here in this study of 491 patients. This was a difficult study to perform and adds avaluable information to our understanding of urethrovesical function in these circumstances.