The effect of radical hysterectomy on bladder physiology.

Voiding dysfunction and vesical sensation and continence problems were serially evaluated by history and CO2 cystourethroscopy in 22 women who had undergone a radical hysterectomy. In 11 of these women, the cardinal ligaments had been divided completely, and in the other 11, the inferior 1 to 2 cm of these ligaments had been spared. Satisfactory voiding occurred significantly earlier (20 versus 51 days) in women who had had an incomplete transection. Vesical sensation was diminished in all subjects, but the magnitude of the sensory deficit was no greater in those who had had a complete transection. Stress incontinence occurred more frequently in those who had had a complete transection. Hypertonic cystometric measurements and decreased intraurethral pressure were common postoperative findings, and it is postulated that sympathetic denervation is responsible for both of these alterations.