(1) Nagoya University Graduate School Of Medicine, Nagoya, Japan
We evaluated the changes in bladder and urethral function over time in patients undergoing nerve-sparing radical hysterectomy by conducting a urodynamic study.
This was a single-centre, prospective study. Female patients undergoing nerve-sparing radical hysterectomy were enrolled. Urethral pressure profiling (UPP) and pressure flow study (PFS) were performed before and 1 and 6 months after the surgery. 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.
Twenty-five patients were included in the study. The total IPSS significantly increased 1 month after the surgery, and thereafter decreased 6 months after the surgery. The changes in the OABSS showed a similar tendency as well (Table 1). UPP showed that the maximum urethral closure pressure (MUCP) significantly decreased 1 month after the surgery, but remained the same 6 months after the surgery as that 1 month after the surgery. The PFS indicated that first desire to void and maximum cystometric capacity were increased 1 and 6 months after the surgery. Bladder contractility index (BCI) and voiding efficiency were decreased 1 month after, but improved 6 months after the surgery (Table 2). Fourteen of the 25 (56%) patients showed a low BCI (<100) 1 month after and 5 (20%) patients still showed a low BCI even 6 months after the surgery. Pre- to post-operative reduction rate of the BCI significantly correlated with pre- to post-operative reduction rate of MUCP (p = 0.004, r = 0.57).
Our study demonstrated that nerve-sparing radical hysterectomy tended to cause impaired detrusor contractility and urethral function. Thus, patients undergoing this procedure should be counselled before the surgery and carefully followed up after the surgery.