Cervical Cancer and Multiple Sclerosis: What is the urodynamic profile? A clinical case study with literature review

Introduction: Bladder and sphincter disorders (BSDs) affect nearly 90% of patients with multiple sclerosis (MS) at some point in their disease. Surgeries for pelvic cancers such as radical hysterectomy and radiation therapy for cervical cancer (CC) are another common cause of urinary complications due to neurogenic or damage to the tissues. The following report describes a representative patient who suffered the compounding effects of MS and conditions of treating cervical cancer on her urodynamic history.

Observation: A 30-year-old female patient, who has been monitored for MS since 2018 and who has been treated with Rituximab, developed CC that was treated in 2022 with surgical removal of the uterus and cervix (extended hysterectomy) and radiation therapy to her pelvis. At that time, she presented with urinary symptoms, including dysuria, the need for abdominal thrusts, and incomplete emptying. The report evaluating her pattern of voiding completed specified that she was doing so at low volumes and not leaking with voiding. An ultrasound evaluation of her kidney prompted an assessment of mild bilateral ureterohydronephrosis. Urodynamic assessment in this patient acquired the following information: bladder hypoesthesia with detrusor hypocontractility and 550 mL post-void residual urine. The patient had a stable detrusor with mild involuntary contraction, adequate compliance, and no evidence of detrusor-sphincter dyssynergia.

Discussion: Involvement of neurovegetative lesions by pelvic surgery may include alteration of the sympathetic and parasympathetic pathways responsible for bladder control, thus producing voiding disorders. Interpretation of bladder radiotherapy as an exacerbation occurs through continued and progressive fibrosis and ischemia of the bladder wall. Multiple sclerosis course can incite a wide variety of symptoms, as we learnt here from this patient that included detrusor hypoactivity along with the other symptoms that she developed, due to a diagnosis of MS and also due to treatment of cervical cancer.

Conclusion: This case highlights the complexity of the interplay between neurological pathology and urogynecological sequelae. Urodynamic assessment is critical for personalized management.