[Late disorders of bladder function after Wertheim operation--an analysis of urodynamic parameters with reference to...

Permanent disturbances of bladder function are the most unpleasant and least tolerated side effects in patients, who underwent Wertheim hysterectomy because of cervical cancer. The cause of this problem with respect to the radical nature of the operation in relation to the possibly and responsible anatomical structures (sacrouterine ligament, parametrium, paracolpium) has not been completely elucidated. The aim of this prospective study was, to determine this interrelation in 39 (out of 120 radically hysterectomised) patients subjected to urodynamic examination preoperatively and 6-8 months postoperatively after Wertheim hysterectomy. With regard to preserved or lost postoperative bladder sensitivity, no correlation was found to either the length of the vaginal cuff or the parametric tissue. A statistically significant correlation was found between the length of the resected parametric tissue and the onset of postoperative stress urinary incontinence. Furthermore, there was a statistically significant correlation between the length of the resected vaginal cuff and the bladder capacity. The urodynamic parameters of maximum flow-rate, flow-time and residuals correlated rather with the radical nature of removal of the parametrial tissue than with the radicality of the vaginal resection, but that was not significant. The study leads to the conclusion, that within the variations of radical hysterectomy with medium radicality (Wagner-Wertheim procedure), the results presented here are not strikingly different regarding postoperative disturbances of bladder function. To determine such differences, investigations after more radical procedures (e.g. Latzko) would be more suitable.