Voiding Dysfunction After Non-urologic Pelvic Surgery
Purpose of Review
Urinary dysfunction is a common entity in patients undergoing radical pelvic surgery for non-urologic malignancies. These dysfunctions may manifest as lower urinary tract symptoms (LUTS) or signs such as urinary retention or leakage. Review of current literature is performed to describe the differing urinary dysfunctions that manifest after colorectal resection, hysterectomy, and sacrectomy.
Conventional radical surgery for pelvic malignancies often will result in debilitating functional problems. As advances in surgical techniques and management options become more available, patients can have better functional outcomes, specifically in the lower urinary tract. Nerve-sparing techniques as well as vascular preservation are becoming more important to preserve function as patient survival is improving. Additionally, newer methods are being explored, such as nerve stimulation for those who are unable to empty adequately. This article also addresses different management options for specific voiding dysfunction that may result from pelvic surgery.
Preventative strategies such as nerve preservation during surgery are an important concept to prevent urinary dysfunction. The goal to good functional outcomes includes maintaining reservoir compliance and capacity as well as allowing proper outlet for voiding. We discuss different modalities to help achieve a functional lower urinary tract for patients with lower urinary tract dysfunction after pelvic surgery.
KeywordsLower urinary tract dysfunction Incontinence Urinary retention Colorectal surgery Hysterectomy Sacrectomy Nerve-sparing surgery
Compliance with Ethical Standards
Conflict of Interest
Felix Cheung declares no potential conflicts of interest.
Jaspreet Sandhu reports personal fees from Boston Scientific, outside the submitted work and is a section editor for Current Urology Reports.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 1.• Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten ULF, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2013;4295:37–49. Minor updates to standardization of urinary dysfunction terminology by the ICS. Google Scholar
- 2.• Chai TC, Birder LA. Physiology and pharmacology of the bladder and urethra [Internet]. Eleventh E. Campbell-Walsh Urol. Elsevier Inc.; 2016. doi: https://doi.org/10.1016/B978-1-4557-7567-5.00069-8 Understanding anatomy/physiology of functional voiding with minor updates.
- 3.Lange MM, van de Velde CJH. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol [Internet]. Nat Publ Group; 2011;8:51–57. Available from: http://www.nature.com/doifinder/10.1038/nrurol.2010.206
- 4.Maas CP, Moriya Y, Steup WH, Klein Kranenbarg E, van de Velde CJ. A prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands. Eur J Surg Oncol 2000, 26, 751, 757;Google Scholar
- 6.Daniels IR, Woodward S, Taylor FGM, Raja A, Toomey P. Female urogenital dysfunction following total mesorectal excision for rectal cancer. World J Surg Oncol. 2006;Google Scholar
- 8.• Ledebo A, Bock D, Prytz M, Haglind E, Angenete E. Urogenital function three years after abdominoperineal excision for rectal cancer. Color Dis 2018;0–2. Evidence supporting worse urinary dysfunction/incontinence in women compared to men after APR surgery compared to control population. Google Scholar
- 10.• Ito M, Kobayashi A, Fujita S, Mizusawa J, Kanemitsu Y, Kinugasa Y, et al. Urinary dysfunction after rectal cancer surgery: results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol 2018; TME can yield optimistic urinary functional outcomes when under the experties of skilled surgeons. Dysfunctional voiding may be overestimated based on study design including patients not catheterized for PVR in the dysfunctional group. Google Scholar
- 11.• Derks M, Van Der Velden J, Frijstein MM, Vermeer WM, Stiggelbout AM, Roovers JPWR, et al. Long-term pelvic floor function and quality of life after radical surgery for cervical cancer. Int J Gynecol Cancer. 2016;26:1538–43. Important prevalance data on urinary dysfunction after radical hyseterctomy for cervical cancer. CrossRefPubMedGoogle Scholar
- 14.• Marin F, Plesca M, Bordea CI, Moga MA, Blidaru A. Types of radical hysterectomies: from Thoma Ionescu and Wertheim to present day. J Med Life [Internet]. 2014;7:172–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4197497%7B&%7Dtool=pmcentrez%7B&%7Drendertype=abstract. Understanding the classifications of radical hysterectomy. Google Scholar
- 16.• Querleu D, Cibula D, Abu-Rustum NR. 2017 Update on the Querleu–Morrow classification of radical hysterectomy. Ann Surg Oncol. 2017; Update on the popular Querleu-Morrow classification. Google Scholar
- 18.•• Raspagliesi F, Bogani G, Spinillo A, Ditto A, Bogliolo S, Casarin J, et al. Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: a multi-institutional experience. Eur J Surg Oncol [Internet]. Elsevier Ltd; 2017;43:2150–6. doi: https://doi.org/10.1016/j.ejso.2017.08.015. A novel approach to nerve preservation and stimulation intraoperatively during radical hysterectomy.
- 21.•• Sun X-L, Wang H-B, Wang Z-Q, Cao T, Yang X, Han J-S, Wu YF, Reilly KH, Wang JL Effect of transcutaneous electrical stimulation treatment on lower urinary tract symptoms after class III radical hysterectomy in cervical cancer patients: study protocol for a multicentre, randomized controlled trial. BMC Cancer; 2017;17:416. Available from: http://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3387-1 The first randomized control trial implemented that may have significant impact on management of non-obstructive urinary retention after radical hysterectomy.
- 23.Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Jt Surg - Ser A. 2005;Google Scholar
- 24.Gunterberg B, Norlen L, Stener B, Sundin T. Neurourologic evaluation after resection of the sacrum. Investig Urol. 1975;Google Scholar
- 26.Phukan R, Herzog T, Boland PJ, Healey J, Rose P, Sim FH, Yazsemski M, Hess K, Osler P, DeLaney TF, Chen YL, Hornicek F, Schwab J How does the level of sacral resection for primary malignant bone tumors affect physical and mental health, pain, mobility, incontinence, and sexual function? Clin Orthop Relat Res Springer US; 2016;474:687–696.Google Scholar
- 27.• Gormley EA, Lightner DJ, Burgio L, Chai T, Clemens Q, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU AUA/SUFU guideline. J Urol. 2014:1–57. A committee that sets guideline updates specifically on overactive bladder. Google Scholar