Observation Of The Change Of Patients' Urodynamics After Type â…¡ Or Type â…¢ Radical Hysterectomy

Objective:To observe the effect on patients'lower urinary tract functions after TypeⅡand TypeⅢradical hysterectomy by urodynamics, which will provide theoretical support for modification of operation option and how to prevent lower urinary tract dysfunction.Methods:With strict criteria for inclusion and exclusion, we have done 161 urodynamics examinations on 97 patients undertaking TypeⅡor TypeⅢradical hysterectomy in our hospital from June 2009 to April 2011. On a voluntary basis, all patients had urodynamic examinations pre-and post-operatively. Examinations above were divided into five groups:36 cases pre-operation (group 1); 33 cases measured when catheter removed after TypeⅡRH (group 2); 32 cases measured when catheter removed after TypeⅢRH (group 3),25 cases measured 6-8 months after TypeⅡRH (group 4) and 35cases measured 6-8 months after TypeⅢRH (group 5). To observe the change of the patients'lower urinary tract functions by urodynamics after these two operations.Results:1. After these two operations all patients had more or less lower urinary tract symptoms. For group 2 and group 3, the incidence of intermittent voiding(39.4% vs 84.4%, P=0.000); urination by the assistance of abdominal pressure (60.6% vs 100%, P=0.000); urinary retention(15.2% vs 46.9%, P=0.002), respectively. For above symptoms there were significant difference between group 2 and group 3.2. The main symptoms appeared 6-8 months after operation were emptying dysfunction; urination by the assistance of abdominal pressure; reduced bladder sensation; nocturnal enuresis; incontinence. Only for the urination by the assistance of abdominal pressure, there were significant difference between group 4 and group 5(45.5% vs 71.4% P=0.015).3. As for the maximum flow rate there was a statistical difference between group 2 and group 3(14.39±6.32ml/s vs 10.89±5.05ml/s, P=0.017), but not for the residual volume and voiding time.4. All patients in group 2 and group 3 had reduced bladder capacity, abnormal bladder sensation, hypo-functioning of detrusor. First sensation of bladder filling(FB) in group 2 and group 3 were 141.97±46.24ml and 202.69±101.92ml, respectively.5. Maximum flow rate, voided volume, voiding time, First desire to void and Maximum cystometric capacity almost recovered to normal in group 4 but not in group 5.Conclusion:1. All our patients undertaking radical hysterectomy (TypeⅡor TypeⅢ) had more or less dysfunction of lower urinary tract,such as:decreased maximum flow rate and average flow rate; prolonged voiding time; increased residual volume; intermittent voiding; hypo-functioning of detrusor and urination by the assistance of abdominal pressure. Patients with TypeⅡRH had more abnormal bladder sensation.2. The function of low urinary tract gradually returned to normal 6-8 months in some urinedynamic index after TypeⅡRH, but not for TypeⅢRH.