BLADDER FUNCTION DISTURBANCES FOLLOWING W ERTHEIM HYSTERECTOMY - ANALYSIS OF URODYNAMIC PARAMETERS IN CONSIDERING OPERATIVE RADICALITY

Permanent disturbances of bladder function are the most unpleasant and least tolerated side effects in patients, who underwent Wertheim hyst erectomy because of cervical cancer. The cause of this problem with re spect to the radical nature of the operation in relation to the possib ly and responsible anatomical structures (sacrouterine ligament, param etrium, paracolpium) has not been completely elucidated. The aim of th is prospective study was, to determine this interrelation in 39 (out o f 120 radically hysterectomised) patients subjected to urodynamic exam ination 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 vagi nal cuff or the parametric tissue. A statistically significant correla tion was found between the length of the resected parametric tissue an d 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 ra ther with the radical nature of removal of the parametrial tissue than with the radicality of the vaginal resection, but that was not signif icant. The study leads to the conclusion, that within the variations o f radical hysterectomy with medium radicality (Wagner-Wertheim procedu re), the results presented here are not strikingly different regarding postoperative disturbances of bladder function. To determine such dif ferences, investigations after more radical procedures (e. g. Latzko) would be more suitable.