Management of voiding dysfunction associated with pelvic malignancies

Abstract

Voiding dysfunction is common after surgical and radiation treatments in patients diagnosed with non‐urological pelvic malignancies. Presentation might vary with lower urinary tract symptoms and/or overactive bladder, urinary retention, or incontinence. We reviewed the most recent literature with the aim of describing various types of urinary dysfunction that manifest after radical treatments for non‐urological pelvic malignancies. Radical surgical or radiation treatment adversely affect other adjacent pelvic organ function, including viscera, pelvic musculature and the peripheral nervous system. This results in direct organ and indirect functional damage to the genitourinary tract. Multiple surgical and radiation modifications are available nowadays, allowing urologists to offer various treatments for better functional lower urinary tract outcomes. Diagnosing and understanding the type and severity of voiding dysfunction plays a key role in tailoring an appropriate treatment plan. The objective to better functional results relies on maintaining adequate bladder compliance and capacity while permitting volitional emptying, ideally through voiding. Management should routinely start with conservative measures, including pelvic floor muscle training with or without a combination of oral medication for urgency incontinence and clean intermittent catheterization for the management of urinary retention. Concomitant or isolated urinary incontinence can be further managed through multiple established surgical approaches. We attempted to address various treatment available for known lower urinary tract symptoms that might have been caused secondary to non‐urological pelvic surgery or radiation. We discuss different diagnostic and treatment modalities individualized for patients with various entities, to help achieve optimal urinary function and improve quality of life.

Summary of evidence on prevention and management of bladder dysfunction in patients after radical hysterectomy

“…The duration of catheter indwelling is also related to bladder dysfunction; the longer the catheter indwelling, the higher the incidence of this disease (Fukuoka et al., 2018 ; Turnbull et al., 2012 ). The pelvic floor muscle strength and the resistance of the bladder outlet are also important factors that affect postoperative urinary retention (Stabholz & Sandhu, 2021 ).…”

“…The pelvic floor muscle strength and the resistance of the bladder outlet are also important factors that affect postoperative urinary retention (Stabholz & Sandhu, 2021).…”