The adverse effects of cervical cancer treatment on bladder function

Abstract

From June 1986 till the end of 1995 we performed radical surgeries on 235 patients with cervical carcinoma, stages Ib and IIa. In 75 patients we performed only radical hysterectomy (RH), in 52 RH+ external radiotherapy (TCT), and in 108 we also used brachi therapy RT+RH+TCT. Indication for the preoperational brachi therapy was the macroscopic rumor size >4cm (Stage Ib2), and for postoperational TCT the indication was the microscopic metastases in lymph nodes, and malign involvement in lymph-vascular space. Bladder dysfunction is a recognized complication following radical hysterectomy, however, the effect of radiation alone or in combination with surgery on bladder function has received little attention. 160 patients who underwent radical hysterectomy with postoperative whole pelvis radiation (RH+RT) were matched for age, stage of disease, and time interval since therapy, with 75 patients who had radical hysterectomy alone (RH). Bladder function was assessed by symptoms and urodynamic evaluation. Altered bladder sensation and voiding problems were associated with surgery, and were more frequent after RH+RT. A greater problem was seen after RH+RT compared to RH. Urinary incontinence was present in 5% of patients prior to therapy. After treatment, incontinence requiring protection developed in 26% of RH patients, and 63% of RH+RT patients. Bladder neck and urethral function was similar in all groups, however, bladder compliance was reduced in RH+RT patients and significantly (P=0.0001) reduced after RH+RT compared to RH alone. This reduction was related to the bladder dose of external radiation and was a factor in the etiology of the urinary incontinence seen in RH+RT patients.