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  • Review Article
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Urological complications after treatment of cervical cancer

Nature Reviews Urology volume 11, pages 110–117 (2014)Cite this article

Subjects

Key Points

  • The exact incidence of lower urinary tract dysfunction after treatment of cervical cancer is not known, but it has decreased in the past two decades

  • Frequently occurring urological disorders after radical surgery are hypocontractility of the bladder, detrusor overactivity, incontinence and low-compliance bladder

  • Neuroanatomical knowledge and concomitant nerve-sparing surgery are essential to reduce lower urinary tract dysfunction after radical hysterectomy

  • Radiation-induced urological complications include radiation cystitis, ureteric stenosis, fibrotic, shrunken, low-compliance bladder and fistula formation

  • Owing to the development of image-guided radiotherapy, fewer radiation-induced urological complications have been reported since 1990

Abstract

Several urological complications can occur after treatment of cervical cancer. Stage IB and IIA cervical tumours are mainly treated by radical hysterectomy; advanced-stage tumours are treated by chemoradiotherapy. In the past two decades, a decrease in complications has been seen due to improvements in therapy, although the exact incidence of lower urinary tract dysfunction is unknown. The main urological complications after radical surgery are hypocontractility of the bladder, detrusor overactivity, incontinence, low-compliance bladder, fistula and hydronephrosis. As a result of improved neuroanatomical knowledge, and consequently nerve-sparing surgery, bladder morbidity has been decreasing. Late radiation-induced urological complications include haemorrhagic cystitis, ureteric stenosis, low-compliance bladder and fistulas. Owing to technological improvements, such as dose reduction and decreased radiation fields, a decrease in radiation morbidity has been observed since 1990.

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Figure 1: Innervation of the urinary tract.
Figure 2: Gross anatomy of the female small pelvis showing the relationship of the pelvic plexuses to pelvic organs.
Figure 3: Coronal section to show the relationships of the urinary bladder, ureters, cardinal ligaments, sacrouterine ligaments and pelvic plexuses.

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Authors and Affiliations

  1. Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands

    Esther M. K. Wit & Simon Horenblas

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Contributions

E.M.K.W. and S.H. contributed to discussions of the content. E.M.K.W. researched the data and wrote the article. E.M.K.W. and S.H. contributed to review and editing of the manuscript before submission.

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Correspondence to Simon Horenblas.

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The authors declare no competing financial interests.

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Wit, E., Horenblas, S. Urological complications after treatment of cervical cancer. Nat Rev Urol 11, 110–117 (2014). https://doi.org/10.1038/nrurol.2013.323

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