Management of Lower Urinary Tract Dysfunction After Radical Hysterectomy With or Without Radiotherapy for Uterine Cervical Cancer

Background/Purpose: Urinary dysfunction is a common long-term sequela after radical hysterectomy (RH), The aims of this study were to investigate the characteristics and treatment response of lower urinary tract dysfunction (LUTD) after RH with or without adjuvant radiotherapy (RT) for uterine cervical cancer. Methods: We analyzed retrospectively 49 patients who developed LUTD after RH with (n = 16) or without (n = 33) RT for stage IB or IIA uterine cervical cancer. Results: The mean interval between RH and first visit for urological management of LUTD was significantly shorter in the RH+RT (5.9 +/- 4.5 years) than the RH (11.3 +/- 9.5; p < 0.05) group. Combined therapy also resulted in a smaller bladder capacity and poorer bladder compliance. Further urological management was given to 29 patients, including a pubovaginal sling procedure in seven, urethral injection of botulinum toxin A in 13, transurethral incision of the bladder neck in three, and augmentation enterocystoplasty in six. Among the patients who received active urological management, 88.9% were satisfied with the outcome. Conclusion: Patients treated with RH+RT are likely to have a worse bladder condition and require urological intervention sooner than those who receive RH alone. Active urological management of LUTD in these patients leads to satisfactory improvements in symptoms of difficult urination and urinary incontinence. [J Formos Med Assoc 2009;108(8):619-626]