[Urodynamic parameters and continence after radical Wertheim-Meigs-Okabayashi hysterectomy]

The aim of this study was to analyse the effects of radical hysterectomy on urodynamic parameters (urethral resistance, functional urethral length, pressure gradients, bladder capacity, residual urine volume, stress urethral pressure profile), on bladder function (detrusor pressure, urgency sensation, flow pattern) and on continence. We reviewed 33 patients who underwent a radical abdominal hysterectomy as described by Wertheim-Meigs-Okabayashi. They were investigated by urodynamic examination preoperatively and 4 resp. 8 months postoperatively. To ascertain bladder dysfunctions and changes of urinary continence as a long term effect of operative procedure a standardized questionnaire was mailed to all patients. The radical abdominal hysterectomy did not alter significantly the urethral resistance, functional urethral length or pressure gradients. The maximal bladder capacity decreased postoperatively from 615 ml to 503 ml (SD 148.5: p = 0.04). The maximal urine flow and the detrusor pressure decreased temporarily (p = 0.01). The residual urinary increased five-fold (p = 0.01) and the first sensation of bladder filling was recognized later, at 4 as at 8 months postoperatively (p = 0.07). Preoperatively 75% of the patients voided by detrusor activity, postoperatively only 16%. 20% of the preoperative continent patients were incontinent during the second measurement (8 months postoperatively). 47% of the previous continent patients complained about incontinence in the questionnaire (4 years postoperatively). Although the patients complained about pollakiuria, urgency (60%) and urge incontinence (39%), 73% of the patients were content with their situation. Although the urethral pressure profile showed no significant alteration, the clinical situation and the deterioration of the parameters bladder capacity, residual urine and flow pattern verified the postoperative disturbances of the lower urinary tract function and the negative effects on continence behaviour.