Despite increasing interest in the topic of detrusor underactivity (DU), its pathophysiology remains unclear. It is known that DU usually develops after radical hysterectomy (1). We evaluated the changes in bladder and urethral function over time in patients undergoing nerve-sparing radical hysterectomy by conducting a urodynamic study.

This was a single-centre, prospective study. Female patients undergoing nerve-sparing radical hysterectomy for cervical carcinoma were enrolled. Urethral pressure profiling (UPP) and pressure flow study (PFS) were performed before and 1 and 6 months after the surgery. Moreover, the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were also evaluated at the time of the urodynamic study.

Twenty-five patients were included in the study. Their mean age was 46±12 years. The total IPSS significantly increased 1 month after the surgery, and thereafter decreased 6 months after the surgery. The changes in the OABSS showed a similar tendency as well (Table 1). UPP showed that the maximum urethral closure pressure (MUCP) significantly decreased 1 month after the surgery, but remained the same 6 months after the surgery as that 1 month after the surgery. The PFS indicated that first desire to void and maximum cystometric capacity were increased 1 and 6 months after the surgery. Bladder contractility index (BCI) and voiding efficiency were decreased 1 month after, but improved 6 months after the surgery (Table 2). Fourteen of the 25 (56%) patients showed a low BCI (<100) 1 month after and 5 (20%) patients still showed a low BCI even 6 months after the surgery. Pre- to post-operative reduction rate of the BCI significantly correlated with pre- to post-operative reduction rate of MUCP (p = 0.004, r = 0.57).

The present study indicated that about half of patients undergoing nerve-sparing radical hysterectomy developed impaired detrusor contractility 1 month after the surgery, which improved 6 months after the surgery, whereas 20% of patients did not show any improvement. Moreover, MUCP also significantly decreased 1 and 6 months after the surgery. Interestingly, patients with greater surgery-induced reduction in BCI showed greater reduction in MUCP. It is possible that radical hysterectomy injures the pelvic nerve as well as the hypogastric nerve, resulting in impaired bladder contractility and internal urethral sphincter.

Our study demonstrated that nerve-sparing radical hysterectomy tended to cause impaired detrusor contractility and urethral function. Thus, patients undergoing this procedure should be counselled before the surgery and carefully followed up after the surgery.

Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy: a prospective pilot study. Eur J Obstet Gynecol Reprod Biol. 2016 Jun;201:131-4. Kruppa J, Kavvadias T, Amann S, Baessler K, Schuessler B.