IJSR International Journal of Scientific Research 2277 - 8179 Indian Society for Health and Advanced Research ijsr-8-3-18414 Original Research Paper subjective and objective analysis of the urinary bladder morbidity in terms of voiding dysfunction following type III radical hysterectomy for carcinoma uterine cervix - a prospective study. Kumar P Dr. Subbiah S Dr. March 2019 8 3 01 02 ABSTRACT

Introduction– Voiding dysfunction after pelvic plexus injury occurs most commonly after radical hysterectomy in females. The true incidence of neurogenic vesicourethral dysfunction after various types of pelvic surgery is unknown, because there are few prospectively studied series of patients with preoperative and postoperative urodynamic evaluation. The incidence has been estimated to range from 16 % to 80 % after radical hysterectomy [1]. These are estimates drawn from past literature and the current incidence is most likely significantly lower, owing to the use of nerve–sparing techniques during these types of pelvic surgery. Aim– The aim of this study was to analyze subjectively and objectively the urinary bladder morbidity in terms of voiding dysfunction following type III radical hysterectomy for carcinoma uterine cervix. Materials and methods– This was a single–institute prospective study.51 patients diagnosed with carcinoma cervix without any voiding dysfunction underwent radical hysterectomy along with uroflowmetry preoperatively and at 1st, 3rd, and 6th months after surgery. Standard statistical tests Fischer exact test for categorical values and Wilcoxon signed rank test for sequential continuous variable were used for analysis. All the data were expressed as mean ± SD or in percentage as needed. The differences were considered to be significant if p value < 0.05. Results– The voiding dysfunction symptoms presented by patients after radical hysterectomy were straining, urinary incontinence, urgency, and dysuria. The overall voiding dysfunction rate at 1st, 3rd, and 6th month after surgery were 35.3 %, 13.8 %, and 3.9% respectively. The most common voiding dysfunction symptom was straining at 1st, 3rd, and 6th month which manifested in 18 (35.3 %), 7 (13.8 %), and 2 (3.9%) patients respectively. Incontinence manifested in 12 (23.5 %), 6 (11.8 %), and 1(2.0%) patients at 1st, 3rd and 6th month after radical hysterectomy. Urgency manifested in 7 (13.7 %), and 4 (7.8 %) patients at 1st, and 3rd month respectively. 5 (9.8%) patients needed catheterization at 1st month only. No patient needed catheterization at 3rd and 6th month. In 51 patients who underwent radical hysterectomy, the preoperative voided volume, maximal flow rate, average flow rate and post–void residual urine were 281±22, 21.7±1.9, 10.3±0.4, and 21.9±16.0 respectively. At 1st month, 3rd month and 6th month after radical hysterectomy these parameters were 266 ± 32, 20.6 ± 2.1, 9.9 ± 0.7, &35.2 ± 32.6; 271 ± 33, 21.1 ± 2.1, 10.0 ± 0.4, & 26.7 ± 22.3; and 278 ± 26, 21.4 ± 2.1, 10.1 ± 0.4, & 22.8 ± 19.3 respectively. In comparison of preoperative data with 1st, 3rd, and 6th month data, the mean value of voided volume, maximum flow rate and average flow rate decreased; and post–void residual urine increased. In comparison of preoperative data with 1st, 3rd and 6th month data, only maximal flow rate revealed a statistically significant difference (p < 0.05). Conclusion –In conclusion, type III radical hysterectomy gives rise to transient alteration in the neurophysiology of the lower urinary tract which may be the cause for voiding dysfunction.