Lower urinary tract function after postoperative radiotherapy in the treatment of cervical cancer

Objective: The aim of this study was the urodynamic assessment of lower urinary tract disturbance intensity (especially urinary incontinence) among irradiated women after the surgical treatment of cervical cancer.

Study design: The analysis included 34 patients after radical hysterectomy and following radiotherapy for cervical cancer in clinical Stage Ib. Only patients without any previous urogynecological disorders were included. Urodynamic diagnostics was performed two weeks after oncological treatment termination.

Results: Urodynamic parameter changes were clearly present at all stages of functional diagnostics. The most remarkable changes included decreased bladder capacity (mean 196 ml) and residual urine volume (mean 19 ml). The mean value of maximal urine flow rate obtained from uroflowmetry was 26 ml/s, but for 20 women it was lower than 20 ml/s. Voiding time and flow time were abnormally delayed with the significant difference of five seconds. Bladder sensation points were increased and maximum cystometric capacity was decreased to 270 ml during filling cystometry. Bladder compliance was 28 ml/cm H2O on average; for the majority of patients it was below 20. Detrusor pressure was increased in 23 cases above 20 cm H2O and mean isometric pressure was 34 cm H2O. Urethral pressures were low, especially while taking effort. Urinary incontinence was diagnosed in 30% of the cases.

Conclusions: The obtained results allow us to conclude that voiding disorders after combined radiotherapy and surgery are often and mainly apply to the detrusor muscle with the domination of functional disturbances. It seems that early quantitative and qualitative changes depend on combined therapy with a standard dose pattern. The presence of functional disorders after oncological treatment should be considered in the planning of prevention and further treatment. Urinary incontinence restricts patients' activity, affects the quality of their lives and is the cause of patient discomfort. Many patients suffering from lower urinary tract pathologies pose a therapeutic problem caused by lack of information.

Urodynamics; Urinary incontinence; Cervical cancer; Radiotherapy; Bladder

[1] Dean R.J., Lytton B.: "Urologic complications of pelvic irradialion". J. Urol., 1978, 119, 64.

[2] Maier U.: "Late urological complications and malignancies after curative radiotherapy for gynecological carcinomas: a retrospective analysis of 10,709 patients". J. Urol., 1997, 158, 814.

[3] Montana G.S., Fowler M.D.: "Carcinoma of the cervix: analysis of bladder and rectal radiation dose and complications". Int. J. Radial. Biol. Phys., 1989, 16, 95.

[4] Mouristen L., Lose G., Glavind K.: "Assessment of women with urinary incontinence". Acta Obstet. Gynecol. Scand., 1998, 77, 361.

[5] Brown J.S., Subak L.L., Gras J. et al.: "Urge incontinence: the patient's prospective". J. Women's Health, 1998, 7 (10),1263.

[6] Lentz G.M.: "Urogynecology". Arnold, London 2000

[7] Abrams P., Cardozo L., Fall M., Griffiths D. J., Rosier P., Ulmsten U. et al.: "The standarisation of terminology of lower urinary tract function: report from the Standarisation Sub-committee of the International Continence Society". Neurourol. Urodyn., 2002, 21, 167.

[8] Robinson J.W., Faris P.O., Scott C.B.: "Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy". Int. J. Radial. Oneal. Biol. Phys., 1999, 44 (3), 497.

[9] Buchali A., Koswig S., Dinges S. et al.: "Impact of filling status of bladder and rectum on their integral dose distribution and the movement of the uterus in the treatment plaanning of gynaecological cancer". Radiother. Oneal., 1999, 52, 29.

[10] Kim R.Y., Megginnis L.S., Spencer S.A. et al.: "Conventional four field pelvic radiotherapy technique without computed tomography- treatment planning in cancer of the cervix: potential geographic miss and its impact on pelvic controln". Int. J. Radiat. Oneal. Biol Phys., 1995, 33, 109.

[11] Olsen A.L., Smith VJ., Bergstrom J.O. et al.: "Epidemiology of surgically managed pelvic prolaps and urinary incontinence" Obstet. Gynecol., 1997, 89 (4), 501.

[12] Branding A.F., Turner W.H.: "The unstable bladder: towards a common mechanism". Brit. J. Urol., 1994, 73, 3.

[13] Vervest H.A.M., Kiewiet de Jonge M., Vervest T.M.J.S. et al.: "Micturition symptoms and urinary incontinence after non-radical hysterectomy". Acta Obstet. Gynecol Scand., 1988, 67, 141.

[14] German K., Bedwani J., Davies J. et al.: "What is the pathophysiology of detrusor hyperreflexia?". Neurolurol. U rodyn, 1993, 12, 335.

[15] Gabella G.: "Hypertrophy of visceral smooth muscles". Anat. Embryo/., 1990, 182, 409.

[16] Farquharson D.I.M., Shingleton H.M., Sanford S.P. et al.: "The short-term effect of pelvic irradiation for gynecologic malignancies on bladder function 1987". Obstet. Gynecol., 70 (81), 81.

[17] Everaert K., van Laecke E., de Muynck M. et al.: "Urodynarruc assessment of voiding dysfunction and dysfunctional voiding in girls and women". Int. Urogyn. J., 2000, 11, 254.

[18] Lin H.H., Yu H.J., Sheu B. Ch.: "Importance of urodynamic study before radical hysterectomy for cervical cancer". Gynecol. Oneal., 2001, 81, 270.

[19] Gosling J.A.: "Structure of lower urinary tract and pelvic floor" Clinics Obstet. Gynecol., 1985, 12 (2), 285.