Abnormal urodynamic findings after radical hysterectomy or pelvic irradiation for cervical cancer

Objective: To assess urodynamic study results in patients with cervical can cer who had received radical hysterectomy or pelvic irradiation or radical hysterectomy with pelvic irradiation. Methods: Forty-two patients with stag e IB cervical cancer after radical hysterectomy (group A), 11 patients at s tage IB or IIA after pelvic irradiation (group B), 15 patients at stage IB or IIA after both radical hysterectomy and pelvic irradiation (group C) and 17 patients at stage IB before treatment (group D) as central were recruit ed for urodynamic examination. The evaluations for each case included a 20- min pad test, uroflowmetry, both filling and voiding cystometry, and stress urethral pressure profile. ANOVA method with Bonferroni test and Pearson c hi(2)-test were utilized for statistical analysis. Results: The mean ages i n sequential groups A, B, C and D were 52.9 +/- 10.2, 62.5 +/- 13.5, 49.8 /- 11.7 and 49.4 +/- 12.5 years (P = 0.02), respectively. The occurring fre quency of either detrusor instability or low bladder compliance was 57%, 45 %, 80% and 24%, respectively. Each group revealed decreased bladder capacit y as 268.4 +/- 102.8, 164.1 +/- 62.9, 233.5 +/- 73.9 and 293.0 +/- 47.2 ml (P < 0.0001). However, the frequency of abdominal strain voiding was 100% i n groups A, B and C as compared to 0% in group D (P < 0.01), and the freque ncy of abnormal residual urine (> 50 mi) was 41%, 27%, 40% and 24%. Althoug h each case showed a poor pressure transmission ratio (<100%), the frequenc y of positive pad test in each group was 81%, 46%, 100% and 18% (P < 0.001) . The functional urethral length decreased in each group and was 2.6 +/- 0. 8, 2.3 +/- 0.8, 2.5 +/- 0.8 and 2.9 +/- 0.6 cm, but there were no significa nt differences in maximal urethral pressure or urethral closure pressure am ong the four groups. Conclusions: Our data show that abnormal urodynamic fi ndings pre-exist in patients with cervical cancer before treatment especial ly in bladder storing function, and that these findings may worsen, or that new abnormal findings may happen after radical hysterectomy or pelvic irra diation, or both. (C) 1998 International Federation of Gynecology and Obste trics.