The frequency, causes and prevention of severe urinary dysfunction after radical hysterectomy

Urinary dysfunction that developed in 58 patients treated by radical hysterectomy, with or without total vaginectomy and whole pelvic irradiation over a 10-year period, was studied retrospectively by case record review and telephone enquiry. Seven of the 58 (12%) were found to be severely handicapped, six by incontinence and enuresis, and one by the complete inability to void. Twenty-one (36%) patients had absent bladder sensation or urine loss that caused only minor inconvenience. Advancing age, the menopause, whole pelvic irradiation, and total vaginectomy did not increase the likelihood of developing long-term urinary problems. The determining factor was whether the most lateral portions of the cardinal and uterosacral ligaments had been resected or spared at the time of surgery. It is concluded that serious disability may be avoided by conserving the lateral portions of the pelvic ligaments while obtaining adequate surgical margins during radical hysterectomy.