Advertisement

International Urogynecology Journal

, Volume 3, Issue 4, pp 292–297 | Cite as

Vaginal cuff size in Wertheim-Meigs radical hysterectomy should be minimized in order to prevent urological complications

  • A. B. F. Crane-Elders
  • F. M. Kauer
  • J. Bouma
  • J. Janssens
Original Article

Abstract

The possible pathogenesis of urological complications after radical hysterectomy was studied, as well as the influence of cesium irradiation prior to hysterectomy. Thirty-two patients were subjected to a full urodynamic examination, including a detailed medical history, cystometry, urethral pressure profiles, uroflowmetry and a carbachol test, all performed prior to and 6 months following therapy for cervical cancer stage Ib or IIa. No specific influence of cesium irradiation prior to surgery could be found. The only determining factor regarding urologic complications after operation was the length of the vaginal cuff excised. With a small cuff excised no urologic problems were seen; with a cuff of more than 3 cm, however, it was found that there was a substantial risk of dysfunction of the lower urinary tract 6 months after therapy. This finding, as well as an abnormal carbachol test, suggests denervation as a causative factor in the pathogenesis of urological complications after radical hysterectomy.

Keywords

Cesium irradiation Radical hysterectomy Urodynamic investigation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wertheim E. Die erweiterte abdominale Operation beim carcinoma colli uteri (auf Grund von 500 Fällen). Berlin-Wien, Urban and Schwarzenberg, 1911Google Scholar
  2. 2.
    Christ F. Prospektive und retrospektive Untersuchungen zur Urodynamik von Harnblase und Harnröhre nach Zervixkrebsoperationen. Erlangen, Habilitationsschrift, 1979Google Scholar
  3. 3.
    Barclay DL, Roman-Lopez JJ. Bladder dysfunction after Schauta hysterectomy. Am J Obstet Gynecol 1975; 123:519–526Google Scholar
  4. 4.
    Roberts JM, Homesley HD. Observations on bladder function following radical hysterectomy using carbon dioxide cystometry. Surg Gynecol Obstet 1978; 147:558–560Google Scholar
  5. 5.
    Seski JC, Dionko AC. Bladder dysfunction after radical abdominal hysterectomy. Am J Obstet Gynecol 1977; 128:643–651Google Scholar
  6. 6.
    Kristensen GB, Frimodt-Moller PC, Poulsen HK, Ulbak S. Persistent bladder dysfunction after surgical and combination therapy of cancer of the cervix uteri stages Ib and IIa. Gynecol Oncol 1984; 18:38–42Google Scholar
  7. 7.
    Scotti RF, Bergman A, Bhatia NN, Ostergard DR. Urodynamic changes in urethrovesical function after radical hysterectomy. Obstet Gynecol 1986; 68:111–119Google Scholar
  8. 8.
    Asmussen M. Bladder and urethral function after radical hysterectomy with lymph node dissection. Proceedings of the 11th Annual Meeting of the International Continence Society, Lund, 1981Google Scholar
  9. 9.
    Forney JP. The effect of radical hysterectomy on bladder physiology. Am J Obstet Gynecol 1980; 138:374–382Google Scholar
  10. 10.
    Westby M, Asmussen M. Anatomical and functional changes in the lower urinary tract after radical hysterectomy with lymph node dissection as studied by dynamic urethrocystography and simultaneous urethrocystometry. Gynecol Oncol 1985; 21:261–276Google Scholar
  11. 11.
    Carenza L, Nobili F, Giacobini S. Voiding disorders after radical hysterectomy. Gynecol Oncol 1982; 13:213–219Google Scholar
  12. 12.
    Smith PH, Ballantyne B. The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery. Br J Surg 1968; 55:929–933Google Scholar
  13. 13.
    Christ F, Wagner U, Debus G. Frühe Harnblasenfunktionsstörungen nach Wertheim-Operationen. Ursachen und therapeutische Konsequenze. Geburtsh u Frauenheilk 1983; 43:380–383Google Scholar
  14. 14.
    Hendriksson L, Ulmsten U. Studies of the urethral closure pressure before and after radical hysterectomies ad modum Wertheim. Proceedings of the 7th Annual Meeting of the International Continence Society, Portoroz, 1977Google Scholar
  15. 15.
    Low JA, Mauger GM, Carmichael JA. The effect of Wertheim hysterectomy upon bladder and urethral function. Am J Obstet Gynecol 1981; 139:826–834Google Scholar
  16. 16.
    Sasaki H, Yoshida T, Noda K, Yachiku S, Minami K, Kaneko S. Urethral pressure profiles following radical hysterectomy. Obstet Gynecol 1982; 59:101–104Google Scholar
  17. 17.
    Buchsbaum HJ. The urinary tract and radical hysterectomy. In: Buchsbaum HJ, Smith JD, eds Gynaecologic and obstetric urology. Philadelphia, WB Saunders 1978: pp. 113–127Google Scholar
  18. 18.
    Mensink HJA, de Jonge MC, Kornelis JA. Urodynamisch onderzoek bij vrouwen met incontinentia urinae. Ned Tijdschr Geneeskd 1980; 124:1950–1954Google Scholar
  19. 19.
    van der Kooi JB, van Wanroy PJA, de Jonge MC, Kornelis JA. Standardisation of stress urethral pressure profile measurements with microtransducers. Proceedings of the 15th Annual Meeting of the International Continence Society, London, 1985Google Scholar
  20. 20.
    Anderson RS, Shepherd AM, Feneley RCL. Microtransducer urethral profile methodology: variations caused by transducer orientation. J Urol 1983; 130:727–728Google Scholar
  21. 21.
    Bouma J, Aalders JG, Timmer PR, Janssens J. Diagnostiek-en behandelingsprotocol van het carcinoma colli uteri. Proceedings of Symposium on Oncological Gynaecology, Groningen, 1982Google Scholar
  22. 22.
    Vervest HAM, Barents JW, Haspels AA, Debruyne FJM. Radical hysterectomy and the function of the lower urinary tract. Urodynamic quantification of changes in storage and evacuation function. Acta Obstet Gynecol Scand 1989; 44:523–529Google Scholar
  23. 23.
    Ralph G, Burmucic R. Zur Frage der funktionellen Störungen des unteren Harntraktes nach der abdominalen Radikaloperation des Zervixkrebses. Geburtsh und Frauenheilk 1985; 45:625–629Google Scholar
  24. 24.
    Farquharson DIM, Shingleton HM, Orr JW Jr, Hatch KD, Hester S, Soong S-J. The short-term effect of radical hysterectomy on urethral and bladder function. Br J Obstet Gynaecol 1987; 94:351–357Google Scholar
  25. 25.
    de Jonge MC, Kornelis JA. The dynamic urethral closure quotient. A new parameter for the differential diagnosis in female urinary incontinence. Proceedings of the 7th Annual Meeting IUGA, Mainz, 1983Google Scholar
  26. 26.
    Glahn BE. Neurogenic bladder diagnosed pharmacologically on the basis of denervation supersensitivity. Scand J Urol Nephrol 1970; 4:13–24Google Scholar
  27. 27.
    Methfessel HD, Methfessel G. Der Karbachol-Test zur Bestimmung der Detrusordenervation nach erweiterter Hysterektomie. Zbl Gynäk 1978; 100:1310–1319Google Scholar
  28. 28.
    Twombly GH, Landers D. The innervation of the bladder with reference to radical hysterectomy. Am J Obstet Gynecol 1956; 71:1291–1300Google Scholar
  29. 29.
    Donker PJ. A study of the myelinated fibers in the branches of the pelvic plexus. Neurourol Urodynam 1986; 5:185–202Google Scholar

Copyright information

© The International Urogynecology Journal 1992

Authors and Affiliations

  • A. B. F. Crane-Elders
    • 1
    • 2
  • F. M. Kauer
    • 1
    • 3
  • J. Bouma
    • 4
  • J. Janssens
    • 1
  1. 1.State University Hospital GroningenGroningenThe Netherlands
  2. 2.Academic Hospital NijmegenGroningenThe Netherlands
  3. 3.Martini Hospital GroningenGroningenThe Netherlands
  4. 4.State University HospitalGroningenThe Netherlands

Personalised recommendations