G. Debusthiede et al., BLADDER FUNCTION DISTURBANCES FOLLOWING W ERTHEIM HYSTERECTOMY - ANALYSIS OF URODYNAMIC PARAMETERS IN CONSIDERING OPERATIVE RADICALITY, Geburtshilfe und Frauenheilkunde, 53(8), 1993, pp. 525-531
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.