ICS
1999, Denver
Informally discussed
posters
Urodynamics
Urodynamic
findings before radical hysterectomy for cevical cancer
H.H. Lin, J.F. Liang, S.C.
Huang
Department of Obstetrics and Gynecology, College of Medicine and the Hospital,
National Taiwan University, Taipei, Taiwan
Aims of the Study: To elucidate the urodynamic findings in patients with cervical cancer before radical hysterectomy and correlate the results with age, parity, menopausal status and cancer stage.
Methods: Between January 1996 and December 1998, all the patients with cervical cancer before radical hysterectomy who underwent urodynamic study (UDS) were recruited. Each patient received a detailed history and physical examination and multichannel UDS including uroflowmetry, filling and voiding cystometry, stress urethral pressure profile and 20-minute pad test. All terminology conforms to the standards recommended by the International Continence Society or Urodynamic Society [1-4]. The urodynamic findings were analyzed and correlated with age, parity, menopausal status and cancer stage.
Results: There were totally 2,160 patients who underwent UDS examination during the period. Of them, 210 (10%) patients were cervical cancer cases before radical hysterectomy. We found that the mean age of the 210 patients was 48.7 ± 11.0 years with a mean parity 3.3 ± 1.7. Forty-four percent (n=99) of the 210 patients were menopausal, and 88% (n=184) belonged to stage IB while 10% (n=20) stage IIA and 2% (n=6) stage IIB. The urodynamic findings showed that only 9% (n=20) of the 210 patients were normal (group I), and 21% (n=43) with storing dysfunction (group II), 4% (n=8) with voiding dysfunction (group III) and 6% (n=12) with urinary incontinence (group IV). Of the remaining, 26% (n=54) had storing dysfunction and urinary incontinence (group V), 2% (n=5) had voiding dysfunction and urinary incontinence (group VI) and 15% (n=32) had both storing and voiding dysfunctions (group VII). The last group (VIII) comprised of 17% (n=36) of the 210 patients with urinary incontinence, storing and voiding dysfunctions. No statistically significant differences were noted in age, parity, menopausal status and cancer stage among the 8 groups. It was noteworthy that 79% (n=165) of the 210 patients had storing dysfunction, 38% (n=81) voiding dysfunction and 51% (n=107) urinary incontinence. Of the 107 patients with urinary incontinence, 36% (n=78) belonged to genuine stress incontinence (GSI) while 7% (n=15) detrusor instability (DI) and 7% (n=14) mixed GSI/DI.
Conclusions: Our data demonstrated that the urodynamic findings before radical hysterectomy for cervical cancer were normal in only 9% of the patients. Among the abnormal urodynamic findings of these patients, 79% had storing dysfunction while 51% with urinary incontinence and 38% with voiding dysfunction. Besides, 60% had two or three dysfunctions of lower urinary tract. Thus, it is mandatory to perform preoperative urodynamic study for cervical cancer before radical hysterectomy in order to definitely determine the impact of such a procedure on the lower urinary tract.
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