Impact of Adjuvant Radiotherapy and Reversibility of Neurogenic Bladder on Bladder Storage Function and Impact of Urethral Resistance on Bladder Emptying Function after Radical Hysterectomy

Abstract

Purpose: To clarify which patients need careful neurourological management after abdominal radical hysterectomy (RH) by investigating the effects of adjuvant radiotherapy and reversibility of neurogenic bladder (NB) on the storage function as well as the effects of urethral resistance on the emptying function. Methods: Data from sixty-two patients referred to our NB clinic after RH were retrospectively reviewed. Findings of urodynamic studies performed at 3 (UDS-1) and 12 (UDS-2) months after treatment were compared, and logistic analysis was used to calculate the odds ratio (OR) of the effects of radiotherapy and irreversible NB on decreased bladder capacity and decreased compliance. Irreversible NB was defined as the need for clean intermittent catheterization at the last follow-up. Results: At the median follow-up period of 41 months, 60% of the patients continued to require clean intermittent catheterization. Of patients with irreversible NB and radiotherapy, 80% had decreased bladder capacity and decreased compliance at UDS-2. For decreased bladder capacity and decreased compliance, ORs of adjuvant radiotherapy at UDS-2 were 38.42 (p < 0.001) and 7.46 (p = 0.001), respectively, while ORs of irreversible NB were 1.64 (p = 0.527) and 3.42 (p = 0.062), respectively. Detrusor contraction could be demonstrated in only 15% and 45% at UDS-1 and UDS-2, respectively. However, regardless of improvement in detrusor contractility, urodynamic studies revealed a high urethral resistance. Conclusions: Careful neurourological follow-up after RH is mandatory for patients who undergo adjuvant radiotherapy and have irreversible NB with impaired urethral relaxation.