Early evaluation of the urinary tract following radical hysterectomy: structure and function relationships

One hundred ten consecutive patients with invasive gynecologic cancers, treated by radical hysterectomy at The University of California, Irvine Medical Center, underwent early postoperative intravenous pyelogram (IVP). An abnormal early postoperative IVP did not predict subsequent urinary tract dysfunction (anatomical defect or disrupted voiding pattern) at 3 months, which occurred in 29% of the patients, nor did it detect any unsuspected fistulas or ureteral obstruction that persisted beyond the 3-month follow-up. Urinary tract dysfunction was not significantly associated with tumor volume, operative blood loss, or the type of radical hysterectomy performed. However, the inability to remove a suprapubic catheter before the 21st postoperative day was associated with a significant increase in urinary tract dysfunction at 3 months (P less than .03). We conclude that, in the absence of intraoperative urinary tract injury or clinical symptoms suggesting fistula or ureteral obstruction, the routine use of postoperative IVP should be abandoned.