Bladder dysfunction after radical abdominal hysterectomy

Bladder dysfunction is a common occurrence following radical hysterectomy. We studied bladder function prospectively in 10 patients before and after radical hysterectomy. Results suggest that the hypertonic phase observed immediately postoperatively is the result of an increase in myogenic tonicity of the detrusor muscle secondary to the trauma of operation and prolonged catheter drainage. The inability of patients to urinate effectively is due to partial detrusor denervation. Combined cystometry and electromyography confirmed the presence of normal sphincter function and the absence of detrusor sphincter dyssynergia. Prevention of postoperative bladder atony includes a careful preoperative urologic evaluation, including cystometry. Postoperative bladder care should emphasize the prevention of overdistention. Inability to empty the bladder after operation may be managed effectively by intermittent self-catheterization, Urecholine, or prolonged catheter drainage. Patients should be evaluated periodically to uncover delayed bladder decompensation.