Voiding Dysfunction After Non-genitourinary Radical Pelvic Surgery

Voiding dysfunction after radical non-genitourinary pelvic surgery is a common but poorly understood entity. It is thought to be multifactorial, likely related to the type of surgery, degree of injury to nerves, degree of injury to urinary tract and vasculature, and (neo)adjuvant therapy. Management is focused on ensuring that the bladder is an adequate storage reservoir with ability to empty volitionally. We review voiding dysfunction caused by radical gynecological, rectal, and sacral surgeries. Voiding dysfunction, although common after radical gynecological, rectal, and sacral surgeries, has been declining due to the recognition of the nerves involved in voiding function and the techniques designed to preserve them. The most common types of voiding dysfunction after radical pelvic surgery are impaired detrusor contractility, detrusor overactivity, reduced bladder compliance, and stress urinary incontinence. Urodynamics testing and upper tract imaging studies are the diagnostic mainstays. Various treatments are available and reviewed in this manuscript. Non-genitourinary radical pelvic surgery often results in voiding dysfunction ranging from urinary retention to urinary incontinence. Treatment is guided by two main principles—ensuring that the bladder is an adequate storage reservoir and preserving the ability to empty volitionally. This can be accomplished by pharmacologic means, intermittent catheterization, and multiple anti-incontinence procedures.