Abstract
Twenty-four women who had radical abdominal hysterectomy, and subsequently developed persistent high post-void residual urine underwent transurethral bladder neck incision. Persistent high post-void residual urine is defined as a residual urine volume 20% greater than the amount just voided. This was determined during a 24-hour period, 3 months or more after the radical hysterectomy. Our results indicated that the bladder outlet resistance before and after the procedure was 0.96±1.01 and 0.19±0.07 respectively (P<0.05). The mean ratios between residual urine and total bladder volume in 24 cases were reduced from 93.45±42.93% to 33.47±22.79% after the procedure (P<0.001). In addition, there was a significant decrease of functional urethral length, maximal urethral closure pressure and bladder outlet resistance. Based on the ratios of residual urine and total bladder volume, 7 patients were markedly improved, 10 were partially improved, 7 remained unchanged and none worsened. The overall improvement rate was 71% (17/24). Urinary incontinence was a rare complication which occurred in only one woman (4%).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Seski JC, Diokno AC. Bladder dysfunction after radical abdominal hysterectomy.Am J Obstet Gynecol 1977; 128:643–651
Twombly GH, Landers D. The innervation of the bladder with reference to radical hysterectomy.Am J Obstet Gynecol 1956; 71:1291–1300
Barrett DM. The effect of oral bethanechol chloride on voiding in female patients with excessive residual urine: a randomized double-blind study.J Urol 1981; 26:640–642
Finkbeiner AE. Is ethanechol chloride clinically effective in promoting bladder emptying? A literature review.J Urol 1985; 134:443–449
Green TH, Meigs JV, Ulfelder H, Curtin RR. Urologic complications of radical Wertheim hysterectomy: incidence, etiology, management and prevention.Obstet Gynecol 1962; 20:293–312
Jonas U, Hohenfellner R. Late results of bladder stimulation in 11 patients: follow up to 4 years.J Urol 1978; 120:565–568
Lapides J, Diokno AC, Lowe BS, et al. Follow-up on unsterile intermittent self-catheterization.J Urol 1974; 111:184–187
Kunin CM. Can we build a better urinary catheter?N Engl J Med 1988; 319:365–366
Sakamoto S. Radical hysterectomy with pelvic lymphadenectomy —the Tokyo method. In: Coppleson M. ed.Gynecologic Oncology. 1st ed. New York: Churchill Livingstone, 1981; 877–886
Stamey TA. Stress urinary incontinence. In: Harrison JH. ed.Campbell's Urology, vol. 3. Philadelphia: W. B. Saunders, 1979; 2272–2280
Stanton SL, Cardozo L, Chaudhury N. Spontaneous voiding after surgery for urinary incontinence.Br J Obstet Gynecol 1979; 85:149–152
Turner-Warwick R, Whiteside CG, Worth PHL, et al. A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and transtrigonal posterior prostatectomy.Br J Urol 1973; 45:44–59
Bhatnagar BNS, Barnes RW. Incontinence following transurethral resection of the bladder neck in the female.Br J Urol 1981; 53:29–34
Pinard CJ Jr. Vesical neck obstruction in the female.Endoscopy 1969; 1:165–169
Jonas U, Petri E, Hohenfellner R. Indication and value of bladder neck incision.Urol Int 1979; 34:260–265
Stanton SL, Cardozo L, William JE, et al. Clinical and urodynamic features of failed incontinence surgery in the female.Obstet Gynecol 1978; 51:515–520
International Continence Society Committee on Standardization of Terminology: 3rd Report: Procedures related to the evaluation of micturition: pressure-flow relationships. Residual urine. Portoroz, Yugoslavia, 1977
Author information
Authors and Affiliations
Additional information
Editorial Comment: Voiding dysfunctions of various types are common problems after radical hysterectomy. Particularly troubling are those related to retention, where the patient must plan to perform intermittent self-catheterization for the rest of her life. If a way could be developed to select patients who would benefit from a procedure to reduce outlet resistance and promote bladder emptying, should this not be welcomed? The author's experience would suggest that there is a way to select patients for such a procedure by determining the individual patient's voiding mechanism and the presence or absence of proximal urethral obstruction. As long as the patient has the ability to produce a detrusor contraction, and when outlet resistance is decreased by bladder neck incisions allowing the bladder neck to funnel, then the patient can empty her bladder by straining as an adjunct to her detrusor contraction. Confirmation of this finding is encouraged not only in radical hysterectomy patients but also in other types of retention.
Rights and permissions
About this article
Cite this article
Wang, A.C. Transurethral incision of bladder neck for voiding dysfunction after radical hysterectomy: A report of 24 cases. Int Urogynecol J 2, 136–140 (1991). https://doi.org/10.1007/BF01997423
Issue Date:
DOI: https://doi.org/10.1007/BF01997423