title: Bladder function after radical hysterectomy for cervical cancer.
abstract: OBJECTIVE
  To report the effects of radical hysterectomy and nerve-sparing techniques on lower urinary tract function in women.
  
  
  METHODS
  A literature search was performed in Pubmed and Medline using the keywords bladder after radical hysterectomy, nerve sparing radical hysterectomy, and urinary dysfunction following radical hysterectomy. Significant results and citations were reviewed manually by the authors.
  
  
  RESULTS
  The sympathetic and parasympathetic systems innervating the lower urinary tract may be disrupted due to resection of uterosacral and rectovaginal ligaments, the dorsal and lateral paracervix, the caudal part of the vesico-uterine ligaments, and the vagina. This supports the neurogenic etiology of early and late bladder dysfunction after radical surgery. Bladder disorders are also related to the extent of radical surgery. The neuropathopysiology of lower urinary tract symptoms after radical hysterectomy is not fully understood. Recent data have highlighted the role of urethral sphincter pressure in the etiology of postoperative incontinence. Various surgical approaches have been developed to preserve autonomic pelvic innervation.
  
  
  CONCLUSIONS
  Nerve-sparing techniques appear to improve bladder function without compromising overall survival. Studies comparing the effects of nerve-sparing radical hysterectomy with standard surgery yielded encouraging results in respect of postoperative lower urinary tract function. Clinical trials with a long period of follow-up are required for better comprehension of the complex pathophysiology of bladder dysfunction after radical hysterectomy.
authors: Division of Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
authors: Rosa M
authors: RM
authors: Laterza
authors: Karl-Dietrich
authors: KD
authors: Sievert
authors: Dirk
authors: D
authors: de Ridder
authors: Mark E
authors: ME
authors: Vierhout
authors: Francois
authors: F
authors: Haab
authors: Linda
authors: L
authors: Cardozo
authors: Philip
authors: P
authors: van Kerrebroeck
authors: Francisco
authors: F
authors: Cruz
authors: Con
authors: C
authors: Kelleher
authors: Christopher
authors: C
authors: Chapple
authors: Montserrat
authors: M
authors: Espuña-Pons
authors: Heinz
authors: H
authors: Koelbl
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
keywords: bladder dysfunction; cervical cancer; nerve sparing; radical hysterectomy