Neurourology pp 577-583 | Cite as

Radical Pelvic Surgery

  • Paul D. SlocumJr
  • Casey G. Kowalik
  • Joshua A. Cohn
  • Roger R. DmochowskiEmail author


Radical pelvic surgery is commonly utilized for the treatment of pelvic malignancy. Radical hysterectomy with bilateral pelvic lymphadenectomy is considered the standard of care for the treatment of early invasive cervical cancer, and radical prostatectomy is utilized for the surgical treatment of prostate cancer. Radical hysterectomy for the treatment of locally invasive cervical cancer (stage IB and IIA) involves removal of the uterus, the parametrium (which includes the round, uterosacral, broad, and cardinal ligaments), the upper third of the vagina, and commonly the pelvic lymph nodes. Radical prostatectomy for the treatment of localized prostate cancer involves removal of the prostate, seminal vesicles, and commonly pelvic lymph nodes and has been shown in clinical trials to reduce progression to metastasis and death from prostate cancer [1, 2]. The goals of radical prostatectomy are to eliminate cancer burden while at the same time preserving urinary control and sexual function [3]. Yet, despite the development of nerve sparing techniques and the use of robotic surgery, urinary symptoms may develop as a result of or persist despite these operations. The ensuing chapter seeks to characterize the symptoms and urodynamic findings demonstrated by patients after radical pelvic surgery.


  1. 1.
    Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002;347:781–9.CrossRefGoogle Scholar
  2. 2.
    Bill-Axelson A, Holmberg L, Filen F, et al. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandanavian prostate cancer group-4 randomized trial. J Natl Cancer Inst. 2008;20:1144–54.CrossRefGoogle Scholar
  3. 3.
    Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128:492–7.CrossRefGoogle Scholar
  4. 4.
    Lue TF, Zeineh SJ, Schmidt RA, et al. Neuroanatomy of penile erection: its relevance to iatrogenic impotence. J Urol. 1984;131:273–80.CrossRefGoogle Scholar
  5. 5.
    Lepor H, Gregerman M, Crosby R, et al. Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol. 1985;133:207–12.CrossRefGoogle Scholar
  6. 6.
    Schlegel P, Walsh PC. Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function. J Urol. 1987;138:1402–6.CrossRefGoogle Scholar
  7. 7.
    Walsh PC. The discovery of the cavernous nerves and development of the nerve sparing radical retropubic prostatectomy. J Urol. 2007;177:1632–5.CrossRefGoogle Scholar
  8. 8.
    Plotti F, Angioli R, Zullo MA, et al. Update on urodynamic bladder dysfunctions after radical hysterectomy for cervical cancer. Crit Rev Oncol Hematol. 2011;80:323–9.CrossRefGoogle Scholar
  9. 9.
    Scotti RJ, Bergman A, Bhatia NN, et al. Urodynamic changes in urethrovesical function after radical hysterectomy. Obstet Gynecol. 1986;68:111–20.PubMedGoogle Scholar
  10. 10.
    Rob L, Halaska M, Robova H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol. 2010;11:292–301.CrossRefGoogle Scholar
  11. 11.
    Bessede T, Sooriakumaran P, Takenaka A, et al. Neural supply of the male urethral sphincter: comprehensive anatomical review and implications for continence recovery after radical prostatectomy. World J Urol. 2017;35:549–65.CrossRefGoogle Scholar
  12. 12.
    Low JA, Mauger GM, Carmichael JA. The effect of Wertheim hysterectomy upon bladder and urethral function. Am J Obstet Gynecol. 1981;139:826–34.CrossRefGoogle Scholar
  13. 13.
    Forney JP. The effect of radical hysterectomy on bladder physiology. Am J Obstet Gynecol. 1980;138:374–82.CrossRefGoogle Scholar
  14. 14.
    Ralph G, Winter R, Michelitsch L, et al. Radicality of parametrial resection and dysfunction of the lower urinary tract after radical hysterectomy. Eur J Gynaecol Oncol. 1991;12:27–30.PubMedGoogle Scholar
  15. 15.
    Manchana T, Prasartsakulchai C, Santingamkun A. Long term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dyfunction. Int Urogynecol J. 2010;21:95–101.CrossRefGoogle Scholar
  16. 16.
    Chen GD, Lin LY, Wang PH, et al. Urinary tract dysfunction after radical hysterectomy for cervical cancer. Gynecol Oncol. 2002;85:292–7.CrossRefGoogle Scholar
  17. 17.
    Chuang TY, Yu KJ, Penn IW, et al. Neurological changes before and after radical hysterectomy in patients with cervical cancer. Acta Obstet Gynecol Scand. 2003;82:954–9.CrossRefGoogle Scholar
  18. 18.
    Kadono Y, Ueno S, Iwamoto D, et al. Chronological urodynamic evaluation of changing bladder and urethral functions after robotic assisted radical prostatectomy. J Urol. 2015;85:1441–7.CrossRefGoogle Scholar
  19. 19.
    Benedetti-Panici P, Zullo MA, Plotti F, et al. Long-term bladder function in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy and type 3–4 radical hysterectomy. Cancer. 2004;100:2110–7.CrossRefGoogle Scholar
  20. 20.
    Song C, Lee J, Hong JH, et al. Urodynamic interpretation of changing bladder function and voiding pattern after radical prostatectomy: a long-term follow-up. Br J Urol Int. 2010;106:681–6.CrossRefGoogle Scholar
  21. 21.
    Porena M, Mearini E, Mearini L, et al. Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency. Eur Urol. 2007;52:38–45.CrossRefGoogle Scholar
  22. 22.
    Leach GE, Trockman B, Wong A, et al. Post-prostatectomy incontinence: urodynamic findings and treatment outcomes. J Urol. 1996;155:1256–9.CrossRefGoogle Scholar
  23. 23.
    Huckabay C, Twiss C, Berger A, et al. A urodynamics protocol to optimally assess men with post-prostatectomy incontinence. Neurourol Urodyn. 2005;24:622–6.CrossRefGoogle Scholar
  24. 24.
    Constantinou CE, Frehia FS. Impact of radical prostatectomy on the characteristics of the bladder and urethra. J Urol. 1992;148:1215–20.CrossRefGoogle Scholar
  25. 25.
    Kleinhans B, Gerharz E, Melekos M, et al. Changes of urodynamic findings after radical retropubic prostatectomy. Eur Urol. 1999;35:217–22.CrossRefGoogle Scholar
  26. 26.
    Goluboff ET, Chang DT, Olsson CA, et al. Urodyanmics and the etiology of post-prostatectomy urinary incontinence. The initial Columbia experience. J Urol. 1995;153:1034–7.CrossRefGoogle Scholar
  27. 27.
    Winters JC, Appell RA, Rackley RR. Urodyanmic findings in post-prostatectomy incontinence. Neurourol Urodyn. 1998;17:493–8.CrossRefGoogle Scholar
  28. 28.
    Foote J, Yun S, Leach GE. Postprostatectomy incontinence: pathophysiology, evaluation and management. Urol Clin N Am. 1991;18:229–41.Google Scholar
  29. 29.
    Majoros A, Bach D, Keszthelyi A, et al. Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study). Neurourol Urodyn. 2006;1:2–7.CrossRefGoogle Scholar
  30. 30.
    Giannantoni A, Mearini E, DiStassi SM, et al. Assessment of bladder and urethral sphincter function before and after radcial retropubic prostatectomy. J Urol. 2004;171:1563–6.CrossRefGoogle Scholar
  31. 31.
    Leach GE, Yun SK. Post-prostatectomy incontinence: part I. The urodynamic findings in 107 men. Neurourol Urodyn. 1992;155:1256–9.Google Scholar
  32. 32.
    Kielb SJ, Clemens JQ. Comprehensive urodyanmics evaluation of 146 men with incontinence after radical prostatectomy. Urology. 2005;66:392–6.CrossRefGoogle Scholar
  33. 33.
    Groutz A, Blaivas JC, Chaikin DC, et al. The pathophysiology of post-radical prostatectomy incontinence: a clinical and video urodynamic study. J Urol. 2000;163:1767–70.CrossRefGoogle Scholar
  34. 34.
    Ficazzola MA, Nitti VW. The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings. J Urol. 1998;180:1317–20.CrossRefGoogle Scholar
  35. 35.
    Minervini R, Felipetto R, Morelli G, et al. Bladder instability and incontinence after radical prostatectomy. Biomed Pharmacother. 1996;50:383–5.CrossRefGoogle Scholar
  36. 36.
    Chao R, Mayo ME. Incontinence after radical prostatectomy: detrusor or sphincteric causes. J Urol. 1995;154:16–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Paul D. SlocumJr
    • 1
  • Casey G. Kowalik
    • 2
  • Joshua A. Cohn
    • 3
  • Roger R. Dmochowski
    • 2
    Email author
  1. 1.Department of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA
  3. 3.Department of UrologyEinstein Healthcare NetworkPhiladelphiaUSA

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