Prevalence and management of (non-fistulous) urinary incontinence in women following radical hysterectomy for early stage cervical cancer

Objectives: 1) to determine the prevalence of urinary incontinence before and after radical surgical treatment for early cervical cancer, 2) to retrospectively analyse the outcome results following the investigation/treatment of incontinence in these women.

Patients and methods: 27 women were studied prospectively by questionnaire prior to surgery and six weeks and three months after surgery (group 1). Seventy-seven women who were more than 12 months post-radical surgery were questioned directly at the follow-up clinic (group 2). Three hundred and two satisfactory responses were obtained to questionnaires sent to general practitioners of patients previously treated by radical surgery for early cervical cancer (group 3).

Results: 14.8% of women reported regular incontinence prior to surgery, and 48.1% and 29.6% of women, respectively, reported regular incontinence six weeks and three months after surgery; 31.2% of women also reported regular incontinence more than 12 months after post-radical surgery. Of the women in the 12-month post-radical surgery group, 16.6% had considered their symptoms of regular incontinence severe enough to attend their local practice for treatment and 14.6% (44 women) were referred for further management. In six of these 44 patients (13.6%), spontaneous resolution of incontinence occurred at varying intervals within the first 12 months following radical surgery. Twenty-four of the 44 women who were referred underwent urodynamic investigation. Of these 24 women, in 17 cases the diagnosis was genuine stress incontinence (GSI), of which, in seven cases (41%) GSI was the sole urodynamic abnormality. In six of these seven cases (85.7%), the women were cured or very greatly improved following treatment with either physiotherapy or surgery. However, only six of the remaining ten cases (60%) with coexistent abnormalities achieved this result. Patients with coexistent impaired bladder compliance showed the poorest result, as only two of the six cases (33%) achieved satisfactory improvement following treatment.

Conclusion: Non-fistulous urinary incontinence following radical pelvic surgery for carcinoma of the cervix despite being a common problem shows a significant spontaneous improvement rate within the first 12 months following surgery. Urodynamics should be a mandatory investigation in patients who complain of persisting problems thereafter. Subjective improvement rates for women with genuine stress incontinence alone are in excess of 85%, being comparable to those of women without any prior history of radical pelvic surgery.

Bladder dysfunction; Cervical cancer; Radical hysterectomy; Stress incontinence; Urodynamics

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