104 patients submitted to primary irradiation for cervix carcinoma were examined by means of urodynamic methods of diagnosis in order to investigate the functional changes of the lower urinary tract induced by therapy. 34 patients could be examined prior to therapy, 19 and 12 patients, respectively, were examined six and 18 months on an average after the treatment. Another group of 70 patients had retrospective check-up examinations with average intervals of five and ten years. Hydronephrosis occurred only as a late result after more than six years in 12% of the irradiated women. The incidence of residual urine, significant bacteriuria, and disturbed sensory function of the bladder was not important. All patients were incontinent two years after the irradiation; 60% of the cases of incontinence were due to the bladder and 40% to the urethra. The increase of urgency incontinence is possibly caused by a radiofibrotic reaction of the bladder, as is shown by correspondent cystometric alterations: the bladder tonicity increased, whereas the bladder capacity decreased. These alterations were only partially reversible. The stress incontinence, however, was found already before the treatment. The maximum urethral closing pressure, which often indicates incontinence due to the urethra, was not modified by the irradiation. An increased stress incontinence, probably caused by advanced age, was found only after six years or later. The problems resulting from functional changes should be taken into consideration in the course of post-therapeutic care, i.e. the patients concerned should be given instructions for a regular bladder training.

译文

通过尿动力学诊断方法检查了104例接受宫颈癌初次照射的患者,以研究治疗引起的下尿路功能变化。治疗前可检查34例患者,治疗后平均6个月和18个月分别检查19例和12例患者。另一组70例患者进行了回顾性检查,平均间隔为5年和10年。在12% 受辐照的妇女中,肾积水仅在超过六年后才发生。残余尿液,明显的细菌尿和膀胱感觉功能紊乱的发生率并不重要。所有患者在照射后两年均失禁; 60% 的失禁病例是由于膀胱和尿道40% 引起的。尿急性尿失禁的增加可能是由膀胱的放射性纤维化反应引起的,如相应的膀胱测压改变所示: 膀胱张力增加,而膀胱容量减少。这些变化只是部分可逆的。然而,在治疗之前就已经发现了压力性尿失禁。最大尿道关闭压力 (通常表示由于尿道引起的尿失禁) 并未通过照射而改变。仅在六年后或更晚才发现可能是由高龄引起的压力性尿失禁增加。在治疗后护理过程中应考虑功能变化引起的问题,即应向有关患者提供定期膀胱训练的指导。

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