The Neurogenic Factor in Vesical Dysfunction Following Radical Hysterectomy for Carcinoma of the Cervix

Abstract

Twenty-seven women who underwent radical hysterectomy with bilateral pelvic lymphadenectomy by Meigs' technique were examined 6 months or more after the operation for possible neurogenic defect in the bladder function, using a test based on the supersensitivity of denervated detrusor muscle cells to cholinergic stimulation, and the results were correlated to the clinical picture. the presence of voiding difficulties is found to be a very reliable sign of damage to the innervation due to the operation, while absence of this symptom does not exclude the presence of even severe paresis. Similarly, the loss of normal desire to void seems to be a very reliable symptom of detrusor paresis, while no conclusions can be based on preserved sensation of bladder filling. Absence of residual urine is by no means rare even in cases of severe paresis, but in many of these patients the degree of bladder emptying varied from one voiding to the next depending, among other factors, on the toilet conditions, the time and the effort required for complete emptying; some patients stated that rectal constipation could cause deterioration of evacuation conditions. the pattern of the autonomous bladder function is described. in connection with a mention of the compensatory role played by abdominal straining the marked and prolonged weakening of straining power following the laparotomy is demonstrated. Clinical recovery cannot be accepted as criterion of neurological regeneration as there may be merely an apparent restitution caused by a masking of the paresis by compensatory factors related to straining, evacuation technique and outlet conditions, while the denervation test still demonstrates lack of re-innervation of detrusor in such symptom-free cases.