Long-term Lower Urinary Tract Dysfunction in Gynecologic Cancer Survivors


Objective: To determine the prevalence of lower urinary tract dysfunction (LUTD) in gynecologic cancersurvivors after radical hysterectomy (RH) as compared to total abdominal hysterectomy (TAH). The impact onquality of life (QOL) was also evaluated. Materials and
Methods: From January to April 2010, 108 gynecologiccancer survivors (52 cervical, 28 ovarian and 28 endometrial cancer patients) who underwent primary surgery atKing Chulalongkorn Memorial Hospital completed the Urogenital Distress Inventory and Incontinence ImpactQuestionnaire (UDI and IIQ). The UDI has 3 subscales for 19 items of symptoms associated with LUTD. The IIQis a QOL questionnaire which has 4 subscales for 30 items refering to degree of urinary incontinence affectingvarious activities and emotions. A higher score indicates a greater impairment of QOL.
Results: The RH groupwas younger (52.3 ± 8.0 years) than TAH group (56.2 ± 9.1 years), with a lower nulliparous rate (13.2% and55.4%) but more sexual activity (56.6% and 21.4%). Median time from primary surgery was the same in bothgroups (5 years, range 3-20). Seventy gynecologic cancer survivors (64.8%) had LUTD, without significantvariation between the two groups (68.6% and 61.4%, respectively). However, the RH group had significantly morestress urinary incontinence (45.1% as compared to 21% for the TAH group) and voiding dysfunction (31.4%and 1.8%). The total scores and scores from most UDI subscales except irritative symptoms were significantlyhigher in the RH group. In contrast, there were no differences in total and all IIQ subscale scores.
Conclusion:Stress urinary incontinence and voiding dysfunction were prevalent in gynecologic cancer survivors after RH.However, there was no impact on QOL when compared to survivors undergoing TAH.