Hypothesis / aims of study
Despite increasing interest in the topic of detrusor underactivity (DU), its pathophysiology remains unclear. It is known that DU usually develops after radical hysterectomy (1). We evaluated the changes in bladder and urethral function over time in patients undergoing nerve-sparing radical hysterectomy by conducting a urodynamic study.
Study design, materials and methods
This was a single-centre, prospective study. Female patients undergoing nerve-sparing radical hysterectomy for cervical carcinoma were enrolled. Urethral pressure profiling (UPP) and pressure flow study (PFS) were performed before and 1 and 6 months after the surgery. Moreover, the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were also evaluated at the time of the urodynamic study.
Interpretation of results
The present study indicated that about half of patients undergoing nerve-sparing radical hysterectomy developed impaired detrusor contractility 1 month after the surgery, which improved 6 months after the surgery, whereas 20% of patients did not show any improvement. Moreover, MUCP also significantly decreased 1 and 6 months after the surgery. Interestingly, patients with greater surgery-induced reduction in BCI showed greater reduction in MUCP. It is possible that radical hysterectomy injures the pelvic nerve as well as the hypogastric nerve, resulting in impaired bladder contractility and internal urethral sphincter.