Urological complications after radical abdominal hysterectomy for cervical cancer

Radical abdominal hysterectomy for cervical cancer is naturally associated with a number of urological complications. In a review of 320 hospital records we found a 6.6% incidence of intraoperative injury to the bladder or ureters; in all cases the tumour had encroached on the organ. The incidence of postoperative fistula formation was 4.4%. Postoperative urodynamic studies of 116 patients after radical hysterectomy, with or without adjuvant radiotherapy, quantified lower urinary tract dysfunction. A prospective study of 40 patients showed that 20% developed urinary stress-incontinence after surgery. Patients who had had surgery only showed an improvement in most urodynamic parameters over the years, while patients who had also had radiotherapy did not. Seventy-eight per cent of the patients after surgery only were satisfied with their condition and, years later, reported no complaints. They may just have become used to them, but half the patients who had also had radiotherapy reported complaints, mainly impaired bladder sensation, frequency and nocturia. Urinary tract dysfunction after radical hysterectomy is inevitable, but meticulous peri-operative management, regular follow-up examinations and psychological support can keep it to a minimum and help the patient to cope.