Skip to main content

Advertisement

SpringerLink
Log in

Voiding Dysfunction After Non-urologic Pelvic Surgery

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

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.

Recent Findings

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

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;

  5. Havenga K, Maas CP, DeRuiter MC, Welvaart K, Trimbos JB. Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol. 2000;18:235–43.

    Article  PubMed  CAS  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;

  7. Kneist W, Junginger T. Long-term urinary dysfunction after mesorectal excision: a prospective study with intraoperative electrophysiological confirmation of nerve preservation. Eur J Surg Oncol. 2007;33:1068–74.

    Article  PubMed  CAS  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.

  9. Hojo K, Vernava AM 3rd, Sugihara K, Katumata K. Preservation of urine voiding and sexual function after rectal cancer surgery. Dis Colon Rectum. 1991;34:532–9.

    Article  PubMed  CAS  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.

  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.

    Article  PubMed  Google Scholar 

  12. Cibula D, Sláma J, Velechovská P, Fischerova D, Zikán M, Pinkavová I, et al. Factors affecting spontaneous voiding recovery after radical hysterectomy. Int J Gynecol Cancer. 2010;20:685–90.

    Article  PubMed  Google Scholar 

  13. Charoenkwan K, Srisomboon J, Suprasert P, Tantipalakorn C, Kietpeerakool C. Nerve-sparing class III radical hysterectomy: a modified technique to spare the pelvic autonomic nerves without compromising radicality. Int J Gynecol Cancer. 2006;16:1705–12.

    Article  PubMed  CAS  Google 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.

    CAS  Google Scholar 

  15. Querleu D, Morrow C. Classifi cation of radical hysterectomy. Lancet Oncol. 2008;9:297–303.

    Article  PubMed  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.

  17. Fujii S, Takakura K, Matsumura N, Higuchi T, Yura S, Mandai M, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol. 2007;107:4–13.

    Article  PubMed  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.

  19. Monga AK, Tracey MR, Subbaroyan J. A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction. Int Urogynecol J. 2012;23:993–1005.

    Article  PubMed  Google Scholar 

  20. • McGee MJ, Grill WM. Selective co-stimulation of pudendal afferents enhances bladder activation and improves voiding efficiency. Neurourol Urodyn. 2014; Understanding physiology of bladder emptying.;33:1272–8.

    Article  PubMed  Google Scholar 

  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.

  22. Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FT. Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Jt Surg - Ser A. 2006;88:1532–9.

    Article  Google Scholar 

  23. Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Jt Surg - Ser A. 2005;

  24. Gunterberg B, Norlen L, Stener B, Sundin T. Neurourologic evaluation after resection of the sacrum. Investig Urol. 1975;

  25. Guo Y, Palmer JL, Shen L, Kaur G, Willey J, Zhang T, et al. Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine [Internet]. 2005;3:106–10. https://doi.org/10.3171/spi.2005.3.2.0106.

    Article  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.

  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.

  28. • Biardeau X, Aharony S, Group TAC, Campeau L, Corcos J. Artificial urinary sphincter: report of the 2015 Consensus Conference. Neurourol Urodyn. 2016;24:8–24. Updated guidelines on evaluation for patients for possible artificial sphincter placement.

    Article  Google Scholar 

  29. Silberstein JL, Poon SA, Maschino AC, Lowrance WT, Garg T, Herr HW, et al. Urinary diversion practice patterns among certifying American urologists. J Urol [Internet] Elsevier Inc. 2013;189:1042–7. https://doi.org/10.1016/j.juro.2012.08.240.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, NYU Winthrop University, Mineola, NY, 11501, USA

    Felix Cheung

  2. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Felix Cheung & Jaspreet S. Sandhu

  3. Department of Urology, Weil Cornell Medical College, New York, NY, 10065, USA

    Jaspreet S. Sandhu

Authors
  1. Felix Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaspreet S. Sandhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaspreet S. Sandhu.

Ethics declarations

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.

Additional information

This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheung, F., Sandhu, J.S. Voiding Dysfunction After Non-urologic Pelvic Surgery. Curr Urol Rep 19, 75 (2018). https://doi.org/10.1007/s11934-018-0824-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-018-0824-x

Keywords

Search

Navigation