Manometric characterization of rectal dysfunction following radical hysterectomy

doi:10.1016/0090-8258(91)90329-4

Gynecologic Oncology

Volume 42, Issue 2, August 1991, Pages 116-119

https://doi.org/10.1016/0090-8258(91)90329-4 Get rights and content

Abstract

Bladder dysfunction thought to be due to partial denervation has been described following radical hysterectomy. Some patients experience acute and chronic rectal dysfunction characterized by difficulty with defecation and loss of defecatory urge. To define this abnormality, anorectal pressure profiles were examined in 15 patients with Stage I carcinoma of the cervix before and after radical hysterectomy. Profiles were done using standard anorectal manometry with a water-infused system. In all patients preoperative manometric profiles were normal; postoperative studies were abnormal in all patients. Features seen include altered relaxation of the internal sphincter, increased distension needed to trigger relaxation, and decreased rectal sensation; external sphincters and resting internal sphincters were unchanged. Postoperatively, 12 patients reported problems with rectal function. A physiologic defect is definable in patients undergoing radical hysterectomy; this suggests disruption of the spinal reflex arcs controlling rectal emptying. These physiologic abnormalities correlate with the clinical symptomatology experienced by some patients. Continuing definition and evaluation of management options in this situation should be useful in developing effective therapy for rectal dysfunction following radical hysterectomy.

References (15)

J.P. Forney
The effect of radical hysterectomy on bladder physiology
Am. J. Obstet. Gynecol.
(1980)
J.R. Woodside et al.
Detrusor hypertoxicity as a late complication of wertheim hysterectomy
J. Urol.
(1982)
L. Carenza et al.
Voiding disorders after radical hysterectomy
Gynecol. Oncol.
(1982)
G. Delgado
Stage I-B squamous cancer of the cervix: The choice of treatment
Obstet. Gynecol. Surv.
(1978)
P.H. Smith et al.
The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery
Br. J. Surg.
(1968)
E.B. Glahn
The neurogenic factor in vesical dysfunction following radical hysterectomy for carcinomas of the cervix
Scand. J. Urol. Nephrol.
(1970)
R. Zanolla et al.
Bladder and urethral dysfunction after radical abdominal hysterectomy: Rehabilitative treatment
J. Surg. Oncol.
(1985)

There are more references available in the full text version of this article.

Cited by (91)

Invasive cervical cancer
2023, DiSaia and Creasman Clinical Gynecologic Oncology
Invasive cervical cancer
2018, Clinical Gynecologic Oncology
Urinary and anal dysfunction after laparoscopic versus laparotomic radical hysterectomy
2015, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
It has been demonstrated that direct injury to the parasympathetic nerves lateral to the vaginal fornix and in the broad ligament of the uterus are responsible for post-hysterectomy constipation [29]. Since RH involves extensive dissection of the pelvic structures, it is probably to cause more damage to the innervations of rectum than would simple hysterectomy [30]. Recently Park et al. [31] confirmed that deficit of rectal sensory function is the characteristic pathophysiology in patients experiencing constipation after RH [31].
The aim of this study was to compare urinary and anal dysfunction after laparoscopic (LRH) and abdominal (ARH) radical hysterectomy for cervical cancer.
Consecutive patients who underwent radical hysterectomy for treatment of cervical cancer were enrolled in this study and divided into two groups, according to the surgical approach. Urinary and anal symptoms were evaluated before and 6 months after surgery.
Fifty-four women were considered: 27 LRH and 27 ARH. Urinary incontinence was significantly more frequent both after LRH (37% vs 86.9%, p = 0.0004) and after ARH (33.3% vs 100%, p < 0.0001); urge incontinence (3.7% vs 29.6%, p = 0.02) and increased bladder sensation (0 vs 22.2%, p = 0.02) were significantly more common postoperatively in patients undergone ARH. In both groups more patients complain about increase of straining during voiding (LRH: 0 vs 34.7%, p = 0.009; ARH: 3.7% vs 29.6% p = 0.02) after surgery. Postoperative constipation by obstructed defecation was more frequent after ARH (Wexner score: 0 vs 2, p = 0.03) but not after LRH.
From our results, laparoscopic approach for radical hysterectomy seems to reduce the postoperative occurrence of urge incontinence, increased bladder sensation and constipation by obstructed defecation, in comparison with abdominal radical surgery.
Surgery for early stage cervical cancer: How radical should it be
2013, Gynecologic Oncology
Less radical or non radical surgery for early-stage cervical cancer has been proposed to reduce morbidity while maintaining oncologic outcomes. Given that a standardized approach to conservative surgery is not yet available, we have summarized the literature on less radical surgery to better inform clinical practice.
MEDLINE R and MEDLINE in-process and non-indexed citations were searched from inception to April 14, 2013 to identify all English-language articles evaluating less-radical or non radical surgery for invasive cervical carcinoma. Articles including patients with squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma were included and a narrative review of the literature is presented.
Radical surgery is associated with significant adverse effects in terms of urinary function, sexual function, and body image. Radical trachelectomy is an accepted fertility-sparing option, but still leads to morbidity from parametrectomy. The importance of the parametrectomy in patients with small early-stage tumors has been questioned recently, and many studies have found simple hysterectomy and simple trachelectomy can be safe in appropriately selected patients. Cone biopsy may be a fertility-sparing option in those patients with a very low risk of parametrial involvement. Neoadjuvant chemotherapy is also being investigated as a method to reduce the need for radical surgery. Sentinel lymph node biopsy is discussed as a method to reduce the morbidity while increasing the sensitivity of pelvic lymph node assessment in women with early cervical cancers. Finally, the treatment of early adenocarcinoma is addressed.
It appears many women with early-stage cervical cancer can be treated less radically than has been done in the past. Large prospective trials are underway to further define candidates for less-radical surgery.
A model for prediction of parametrial involvement and feasibility of less radical resection of parametrium in patients with FIGO stage IB1 cervical cancer
2012, Gynecologic Oncology
The objective of this study was to evaluate the potential risk factors associated with parametrial invasion and to identify preoperatively a subgroup of patients at low risk for parametrial involvement who could be appropriate candidates for less radical surgery in FIGO stage IB1 cervical cancer.
We retrospectively reviewed the medical records of 317 FIGO stage IB1 cervical cancer patients undergoing class III radical hysterectomy and bilateral pelvic lymphadenectomy. Clinocopathologic factors associated with parametrial invasion were analyzed and the risk criteria predicting parametrial involvement were calculated using a logistic regression model.
Of 317 patients, 17 patients (5.4%) had parametrial involvement. Tumor size > 3 cm (OR, 3.80; [95% CI, 1.19–12.06]; p = 0.02) and pelvic lymph node metastasis (OR, 3.02; [95% CI, 1.04–8.79]; p = 0.04) were independent pathologic factors for parametrial invasion on multivariate analysis. Significant preoperative factors associated with parametrial involvement were tumor size > 3 cm (OR, 4.29; [95% CI, 1.43–12.89]; p < 0.01) and serum SCC Ag level > 1.40 ng/mL (OR, 3.27; [95% CI, 1.11–9.69]; p = 0.03). We identified 185 low-risk (tumor size ≤ 3 cm and SCC ≤ 1.4 ng/mL) and 132 high-risk (tumor size > 3 cm and/or SCC > 1.4 ng/mL) patients. The rates of parametrial involvement in low- and high-risk patients were 1.1% and 11.4%, respectively (p < 0.01).
In this dataset, a model using tumor size and SCC Ag level is highly predictive of parametrial involvement in patients with stage IB1 cervical cancer and may identify candidates for less radical parametrial resection.
Invasive Cervical Cancer
2012, Clinical Gynecologic Oncology: Eighth Edition

View all citing articles on Scopus

View full text

Slide presentationManometric characterization of rectal dysfunction following radical hysterectomy

Abstract

Am. J. Obstet. Gynecol.

J. Urol.

Gynecol. Oncol.

Stage I-B squamous cancer of the cervix: The choice of treatment

Obstet. Gynecol. Surv.

The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery

Br. J. Surg.

The neurogenic factor in vesical dysfunction following radical hysterectomy for carcinomas of the cervix

Scand. J. Urol. Nephrol.

Bladder and urethral dysfunction after radical abdominal hysterectomy: Rehabilitative treatment

J. Surg. Oncol.

Slide presentation
Manometric characterization of rectal dysfunction following radical hysterectomy