2006 Volume 52 Issue 4 Pages 588-595
Objecttive : To demonstrate an improved method for radical hysterectomy procedures to prevent post-operative variable bladder dysfunction. This study presents the results of a Urodynamic Study performed in subjects who underwent radical hysterectomy to clarify the efficacy of the new surgical method. Materials : Participants in this study consisted of 40 Stage 1B cervical cancer patients. These 40 participants were divided into two categories. The control group, consisting of 21 patients, underwent surgery by the established procedure. The experimental group was treated by our improved surgical method for retaining pelvic autonomic nerve function after radical hysterectomy. The groups were further divided into those who received radiation therapy and those who did not require radiation therapy. Methods : Two UDS (Urodynamic Study) methods were chosen to estimate bladder function; cystometry and uroflowmetry. The cystometry measurement parameters indicate bladder pliancy at the point of maximum desire to void. The uroflowmetry measurement parameters indicate the time required from post-surgical dysfunctional urinary flow pattern to the recovery of a normal pattern. Initial cystometry and uroflowmetry measurements were established pre-operatively. Further measurements were taken 1, 3, 6, 12, and 24 months post-operation. Measurements and Results : Four groups were divided as indicated in the methods section above. The non-radiated group who underwent our improved surgical method showed significantly better quality of improvement in cystometry measurements compared to those treated by the established method on measurements obtained 24 months post-operatively. Even the group requiring post-op radiation showed significantly better results at the 1 and 24 month points. At the 24 month point, the group receiving radiation therapy showed the lowest level of pliancy improvement, indicating a tendency for a longer recovery time than this study allowed. Irrespective of radiation therapy, the groups undergoing our improved surgical method achieved a quicker recovery from the post-op dysfunctional pattern to a normal urinary flow pattern. A ten-year post-op recurrence rate survey indicated that there was no significant difference in recurrence rates between the two groups. Conclusion : The new surgical method with improvements in retaining pelvic autonomic nerve function following radical hysterectomy shows significantly better results in bladder pliancy and post-op urinary flow pattern recovery. Post-surgical radiation therapy factors severely affect the recovery time, however, the new method indicates a tendency toward better quality improvement in bladder pliancy and post-op urinary flow pattern recovery.
