Bladder dysfunction after Schauta hysterectomy. One-year follow-up

The purpose of this study was to determine the long-term effect of Schauta hysterectomy on bladder function as determined by serial cystometric studies. The maximum bladder capacity, resting pressure at maximum capacity, and volume of residual urine were determined preoperatively, postoperatively, at time of final catheter removal, and one or more years after surgery. A prior report showing that the bladder decreased in capacity, increased in tone, and, emptied poorly if at all postoperatively was confirmed. The mean duration of postoperative catheter drainage in 68 patients was 33 days. One year or more after surgery the mean maximum bladder capacity had returned to the preoperative volume; persistent elevation of the mean resting pressure was significant in the pooled but not in the paired data; the mean residual urine volume of 25 ml. was significantly elevated. The assumption was that maintenance of intrinsic detrusor muscle tone by prevention of overdistention preserved balanced bladder function. Many patients initiated and maintained micturition by voluntary straining or by use of Crede's maneuver although others voided relatively normally. Presumably these bladders are denervated to varying degrees, producing a spectrum of functional disturbance. The "bladder-conscious" patient can protect and preserve bladder function but these bladders appear to remain vulnerable to infection and overdistention, perhaps permanently.