Sekido N, Kawai K, Akaza H
Department of Urology, University of Tsukuba, Japan.
Int J Urol. 1997 May;4(3):259-64. doi: 10.1111/j.1442-2042.1997.tb00183.x.
This study was performed to evaluate late effects on the lower urinary tract after radical hysterectomy.
We studied 9 women treated with radical hysterectomy for cervical cancer. All patients underwent surgery more than 10 years age (range, 14 to 36 years). Six patients had urologic complications associated with lower urinary tract dysfunction. The remaining 3 were referred for urinary tract abnormalities detected by radiologic examinations. Lower urinary tract function was evaluated with thorough history taking, laboratory examinations, intravenous urography, and conventional urodynamic studies.
Obstructive voiding symptoms and/or urinary incontinence were observed in 7 patients. Uroflowmetry, which was assessable in 7 patients, revealed intermittent flow and a significant amount of residual urine in all patients. Cystometry revealed impaired bladder sensation, detrusor areflexia, straining on voiding, and probable impaired relaxation of the sphincter in all assessable patients. In addition, decreased bladder compliance was observed in 5 patients.
All of the examined patients had severe and complicated urinary tract dysfunctions, even at more than 10 years after surgery. Careful follow-up may be mandatory for patients after radical hysterectomy, because compensating factors tend to mask their urologic symptoms.
本研究旨在评估根治性子宫切除术后对下尿路的远期影响。
我们研究了9例因宫颈癌接受根治性子宫切除术的女性。所有患者手术时间均超过10年（范围为14至36年）。6例患者出现与下尿路功能障碍相关的泌尿系统并发症。其余3例因影像学检查发现尿路异常而就诊。通过全面的病史采集、实验室检查、静脉肾盂造影和传统尿动力学研究对下尿路功能进行评估。
7例患者出现排尿梗阻症状和/或尿失禁。7例患者可进行尿流率测定，结果显示所有患者均存在间歇性尿流和大量残余尿。膀胱测压显示所有可评估患者膀胱感觉受损、逼尿肌无反射、排尿时用力以及可能存在括约肌松弛受损。此外，5例患者膀胱顺应性降低。
所有接受检查的患者即使在术后10多年仍存在严重且复杂的尿路功能障碍。根治性子宫切除术后的患者可能必须进行仔细的随访，因为代偿因素往往会掩盖其泌尿系统症状。
