Wertheim radical hysterectomy 1921-1986: changes in urologic complications.

In order to assess the incidence and type of urologic complications associated with Wertheim's radical hysterectomy we studied all 154 patients undergoing radical hysterectomy at our department between 1980 and 1986. More than 2/3 of patients had stage I carcinoma of the cervix, the mean age was 46.9 years (range 27-73 years). Various intraoperative reconstructive procedures were required in 5%. A comparison with the experience of Wertheim (before 1919) and that of a subsequent time period (1952-1967) showed that while the incidence of intraoperative injury to the lower urinary tract remained stable, the incidence of postoperative fistula formation decreased significantly (from 6.4% to 0.6%), possibly due to changes in the operative technique. We conclude that Wertheim's radical hysterectomy now involves only a very low risk of injury to the bladder or to the ureter.