Iio S, Yoshioka S, Nishio S, Yokoyama M, Iwata H, Takeuchi M
Department of Urology, Ehime University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1993 Mar;84(3):535-40. doi: 10.5980/jpnjurol1989.84.535.
Bladder dysfunction after radical hysterectomy and/or radiotherapy for uterine cancer is a serious problem. Its pathogenesis has not been well elucidated. Urodynamic and clinical evaluations were performed in 53 patients; 24 of them underwent radical hysterectomy and postoperative radiotherapy (RH + RT), 13 had radical hysterectomy alone (RH), 7 had modified radical hysterectomy (mRH), 9 had radiotherapy alone (RT). Nine preoperative patients without micturition disturbance were examined, serving as controls. Patients with more than 50 ml of residual urine were only 3 in RH + RT, 2 in RH and 1 in RT. Bladder volumes at maximum desire to void were significantly lower in RT than in controls. Intravesical pressures at maximum desire to void were significantly higher in RH + RT and RH than in controls, but there were no significant differences between mRH or RT and controls. Detrusor compliances significantly decreased after radical hysterectomy and/or radiotherapy. Maximum urethral closure pressures significantly decreased after radical hysterectomy with or without radiotherapy. In RH + RT, 18 patients (75%) of them mainly complained of urinary incontinence. Their functional profile lengths were significantly shorter than in controls. We conclude that the pelvic plexus injury by radical hysterectomy compromise both urethral closure function and bladder compliance.
子宫癌根治性子宫切除术后和/或放疗后膀胱功能障碍是一个严重问题。其发病机制尚未完全阐明。对53例患者进行了尿动力学和临床评估；其中24例行根治性子宫切除术后放疗（RH + RT），13例仅行根治性子宫切除术（RH），7例行改良根治性子宫切除术（mRH），9例仅行放疗（RT）。对9例术前无排尿障碍的患者进行检查，作为对照。残余尿量超过50 ml的患者在RH + RT组有3例，RH组有2例，RT组有1例。RT组患者最大排尿意愿时的膀胱容量显著低于对照组。RH + RT组和RH组患者最大排尿意愿时的膀胱内压显著高于对照组，但mRH组或RT组与对照组之间无显著差异。根治性子宫切除术后和/或放疗后逼尿肌顺应性显著降低。无论是否接受放疗，根治性子宫切除术后最大尿道闭合压均显著降低。在RH + RT组中，18例患者（75%）主要抱怨尿失禁。他们的功能轮廓长度显著短于对照组。我们得出结论，根治性子宫切除术对盆腔神经丛的损伤损害了尿道闭合功能和膀胱顺应性。
