Long-term bladder function in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy and type 3-4 radical hysterectomy

BACKGROUND. The objective of the current study was to evaluate the incidence of long-term bladder dysfunction after type 3-4 radical hysterectomy in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy (NACT). METHODS. A case-control study was conducted to evaluate the occurrence of long-term bladder dysfunction in 76 patients with International Federation of Gynecology and Obstetrics Stage IB-IIA (> 4 cm), Stage IIB, and Stage III cervical carcinoma who underwent type 3-4 radical hysterectomy after NACT. Preoperative assessment included acquisition of a standardized urogynecologic history, evaluation of severity of urinary incontinence symptoms, maintenance of a 3-day voiding diary, pelvic examination, urogynecologic physical examination, urodynamic assessment, and estimation of hydronephrosis. Follow-up was carried out at least 12 months after surgery. RESULTS. Urinary symptoms (sensory loss, difficult micturition, severe urinary incontinence) were reported by 20 patients (26%). Eighteen patients (24%) had a normal urodynamic profile, 16 patients (21%) had detrusor overactivity, 22 patients (29%) had urodynamic stress incontinence, 2 patients (2%) had aconctractile detrusor, and 18 patients (24%) had mixed urinary incontinence. The length of vagina removed was significantly greater among patients who had detrusor overactivity and mixed urinary incontinence compared with patients who had a normal diagnosis. CONCLUSIONS. The observed rate of bladder dysfunction was higher than the corresponding rate reported in the literature (76%). Three main disturbances were found: detrusor overactivity (21%), mixed urinary incontinence (24%), and de novo stress incontinence (21%). Detrusor overactivity was related to a prevalence of hypertonic bladder. Among patients who underwent type 4 radical hysterectomy, the extent of caudal resection of rectovaginal ligaments and vagina] tissue was found to be more strongly associated with bladder dysfunction than was the extent of lateral parametrial resection. Despite the fact that 76% of patients had abnormal urodynamic parameters, most patients were satisfied with their voiding condition. (C) 2004 American Cancer Society.