Prevalence and management of (non-fistulous) urinary incontinence in womenfollowing radical hysterectomy for early stage cervical cancer

Objectives: 1) to determine the prevalence of urinary incontinence before a nd after radical surgical treatment for early cervical cancer. 2) to retros pectively analyse the outcome results following the investigation/treatment of incontinence in these women. Patients and Methods: 27 women were studied prospectively by questionnaire prior to surgery and six weeks and three months after surgery (group I). Se venty-seven women who were more than 12 months post-radical surgery were qu estioned directly at the follow-up clinic (group), Three hundred and two sa tisfactory responses were obtained to questionnaires sent to general practi tioners of patients previously treated by radical surgery for early cervica l cancer (group 3). Results: 14.8% of women reported regular incontinence prior to surgery, and 48.1% and 29.6% of women, respectively, reported regular incontinence six weeks and three months after surgery; 31.2% of women also reported regular incontinence more than 12 months after post-radical surgery. Of the women i n the 12-month post-radical surgery group, 16.6% had considered their sympt oms of regular incontinence severe enough to attend their local practice fo r treatment and 14.6% (44 women) were referred for further management. In s ix of these 44 patients (13.6%), spontaneous resolution of incontinence occ urred at varying intervals within the first 12 months following radical sur gery. Twenty-four of the 44 women who were referred underwent urodynamic in vestigation. Of these 24 women. in 17 cases the diagnosis was genuine stres s incontinence (GSI), of which, in seven cases (41%) GSI was the sole urody namic abnormality. In six of these seven cases (85.7%), the women were cure d or very greatly improved following treatment with either physiotherapy or surgery. However. only six of the remaining ten cases (60%) with coexisten t abnormalities achieved this result. Patients with coexistent impaired bla dder compliance showed the poorest result, as only two of the six cases (33 %) achieved satisfactory improvement following treatment. Conclusion: Non-fistulous urinary incontinence following radical pelvic sur gery for carcinoma of the cervix despite being a common problem shows a sig nificant spontaneous improvement rate within the first 12 months following surgery. Urodynamics should be a mandatory investigation in patients who co mplain of persisting problems thereafter. Subjective improvement rates for women with genuine stress incontinence alone are in excess of 85%, being co mparable to those of women without any prior history of radical pelvic surg ery.