Co esponding au ho : K. DAAIFI
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Ce ical Cance and Mul iple Scle osis: Wha is he u odynamic p o ile? A clinical case
s udy wi h li e a u e e iew
K. DAAIFI *, S. SKALLI, I. EL AZHARY, L. ESSOUAYNI and S. KARKOURI
Depa men o Physical and Rehabili a ion Medecine, Ibn Sina Uni e si y Hospi al o Raba , Facul y o Medicine and
Pha macy o Raba , Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(03), 080-085
Publica ion his o y: Recei ed on 25 July 2025; e ised on 29 Augus 2025; accep ed on 02 Sep embe 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.3.3119
Abs ac
In oduc ion: Bladde and sphinc e diso de s (BSDs) a ec nea ly 90% o pa ien s wi h mul iple scle osis (MS) a
some poin in hei disease. Su ge ies o pel ic cance s such as adical hys e ec omy and adia ion he apy o ce ical
cance (CC) a e ano he common cause o u ina y complica ions due o neu ogenic o damage o he issues. The
ollowing epo desc ibes a ep esen a i e pa ien who su e ed he compounding e ec s o MS and condi ions o
ea ing ce ical cance on he u odynamic his o y.
Obse a ion: A 30-yea -old emale pa ien , who has been moni o ed o MS since 2018 and who has been ea ed wi h
Ri uximab, de eloped CC ha was ea ed in 2022 wi h su gical emo al o he u e us and ce ix (ex ended
hys e ec omy) and adia ion he apy o he pel is. A ha ime, she p esen ed wi h u ina y symp oms, including
dysu ia, he need o abdominal h us s, and incomple e emp ying. The epo e alua ing he pa e n o oiding
comple ed speci ied ha she was doing so a low olumes and no leaking wi h oiding. An ul asound e alua ion o he
kidney p omp ed an assessmen o mild bila e al u e e ohyd oneph osis. U odynamic assessmen in his pa ien
acqui ed he ollowing in o ma ion: bladde hypoes hesia wi h de uso hypocon ac ili y and 550 mL pos - oid
esidual u ine. The pa ien had a s able de uso wi h mild in olun a y con ac ion, adequa e compliance, and no
e idence o de uso -sphinc e dyssyne gia.
Discussion: In ol emen o neu o ege a i e lesions by pel ic su ge y may include al e a ion o he sympa he ic and
pa asympa he ic pa hways esponsible o bladde con ol, hus p oducing oiding diso de s. In e p e a ion o bladde
adio he apy as an exace ba ion occu s h ough con inued and p og essi e ib osis and ischemia o he bladde wall.
Mul iple scle osis cou se can inci e a wide a ie y o symp oms, as we lea n he e om his pa ien ha included
de uso hypoac i i y along wi h he o he symp oms ha she de eloped, due o a diagnosis o MS and also due o
ea men o ce ical cance .
Conclusion: This case highligh s he complexi y o he in e play be ween neu ological pa hology and u ogynecological
sequelae. U odynamic assessmen is c i ical o pe sonalized managemen .
Keywo ds: Mul iple scle osis; Ce ical cance ; Bladde -sphinc e diso de s; U odynamics; De uso
hypocon ac ili y; Hys e ec omy; Pel ic adio he apy
1. In oduc ion
Mul iple scle osis (MS) is an au oimmune disease o he cen al ne ous equen ly associa ed wi h u ina y ac
dys unc ion, a ec ing up o 96 % o pa ien s wi hin he i s 10 yea s o disease p og ession (1).
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Ce ical cance is he ou h mos common cance among women wo ldwide. In A ica, i anks second in incidence and
mo ali y, wi h 117,316 new cases and 76,745 dea hs (2,3). . Ea ly-s age disease is usually ea ed wi h o al o ex ended
colpohys e ec omy combined wi h pel ic lymphadenec omy , o en leading o a o able ou come (4). Howe e , his
su gical app oach is equen ly associa ed wi h u ina y ac complica ions, wi h epo ed incidence anging om 12%
o 85% (5). While each o hese condi ions can independen ly lead o u ina y ac symp oms, hei coexis ence is a e
and equi es ailo ed managemen / p esen s unique managemen challenges.
In his a icle, we epo he case o a pa ien diagnosed wi h bo h MS and ce ical cance and we highligh clinical impac
o his associa ion on lowe u ina y ac unc ion.
2. Ma e iel and me hods
Clinical case o a young pa ien who has been ecei ing ca e in he Physical and Rehabili a ion Medicine Depa men a
he Uni e si y Hospi al Ibn Sina o Raba , Mo occo, o he assessmen and managemen o he u ina y ac symp oms.
3. Case s udy
A 30-yea -old single woman has been unde neu ological ca e since 2018 o agg essi e mul iple scle osis ea ed wi h
Ri uximab. A e ou yea s o disease p og ession and due o he immunode iciency, she was diagnosed wi h ea ly-
s age ce ical cance . This was su gically managed in No embe 2022 wi h a o al hys e ec omy ex ended o he
pa ame ium, ollowed by adio he apy.
She expe iences spon aneous u ina ion and pe cei es he u ge o oide, bu has di icul y in ia ing u ina ion / s uggles
o s a u ina ing, o en needing o push wi h he abdomen. E en a e she manages o u ina e, she eels incomple e
bladde emp ying.
To manage he u ina y ac issues, a ho ough assessmen was conduc ed:
• F equency- olume cha : Main ained o e h ee consecu i e days, eco ding iming, amoun , and
equency o he luid in ake and u ina ion. Analysis showed no mal luid in ake (2-2.5 li e ), u ina ion
olumes be ween 100 and 300 ml a egula in e als, and no epo ed leakage.
• Vesico enal ul asound: Showed mild bila e al u e e ohyd oneph osis, no e iden endoluminal
obs uc ion, and wo bila e al enal co ical cys s we e ound, wi hou signs o malignancy.
• Biological es s : Cy obac e iological examina ion o u ine and enal unc ion es s we e no mal.
• U odynamic assessmen :
o Flow measu emen : Conduc ed in si ing posi ion wi h no mal oiding desi e. The pa ien u ina ed wi h
di icul y, oiding 450 ml. Pos - oid ca he e iza ion e ealed a esidual olume o 550 ml. (Annex 1)
o P essu e low s udy: Pe o med in a gynecological posi ion wi h a illing a e o 30ml/min. Fi s sensa ion
occu ed a 400 ml, wi h a no mal sensa ion occu ing a 453 ml. The de uso was s able and showed
no mal compliance. No leakage was obse ed. Cys ome ic capaci y was 497 ml.
Du ing oiding, he e was no de uso con ac ion, and he pa ien was unable o ini ia e mic u i ion despi e abdominal
h us s, (Annex 2)
• P o ilome y: Baseline u e h al p essu e was 25 cmH2O, maximum u e h al p essu e was 110 cmH2O, closu e
p essu e was 80 cmH2, and he unc ional leng h o he p o ile was 71 mm. Annex 3
U odynamic es ing indica ed bladde hyposensi i i y wi h de uso hypocon ac ili y.
In o al, The pa ien was a 30-yea -old woman being ea ed o MS and ce ical cance , which had been ope a ed on
and i adia ed, who p esen ed wi h dysu ia. The es s indica ed bladde hyposensi i i y and de uso hypocon ac ili y
wi h ea ly epe cussions on he uppe u ina y ac . Medical ea men wi h an icholine gics was indica ed, along wi h
aining in in e mi en ca he e iza ion.
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4. Discussion
4.1. Neu o-u ological consequences o o al colpohys e ec omy o ce ical cance ea men
The pa hophysiology o lowe u ina y ac dys unc ion (LUTD) ollowing o al colpohys e ec omy is mul i ac o ial,
in ol ing bo h neu o ascula comp omise o he esico-u e h al appa a us and s uc u al inju y o he pel ic loo
suppo sys em. De ailed cada e ic dissec ion s udies ha e elucida ed he ana omical cou se o sympa he ic and
pa asympa he ic ibe s wi hin he lesse pel is, as well as hei close ela ionship o he issues excised du ing adical
hys e ec omy (6).
The mechanisms, se e i y, and ana omical le el o neu al inju y a y be ween indi iduals. Sympa he ic ibe s a ising
om he supe io hypogas ic plexus a e a isk o ansec ion o ac ion inju y a he pel ic b im, p oximal o he
u e e , pa icula ly du ing he lymphadenec omy s age. The in e io hypogas ic plexus—a complex ne wo k con eying
bo h sympa he ic and pa asympa he ic ibe s—is ulne able o inju y a he le el o he ca dinal ligamen and/o he
esicou e ine ligamen (7).
The p ognosis o hese inju ies depends on he ype and ex en o neu al damage. T ac ion- ela ed neu op axia du ing
dissec ion o en esol es spon aneously wi hin days. In con as , axono mesis wi h p ese a ion o he epineu ium
allows o po en ial egene a ion, whe eas comple e neu o mesis p ecludes eco e y (8).
Sympa he ic pa hway lesions ypically esul in educed bladde compliance, ele a ed de uso illing p essu es, and
inadequa e coap a ion o he bladde ou le du ing s o age. Pa asympa he ic pa hway dis up ion may lead o de uso
unde ac i i y o acon ac ili y, while inju y o a e en pa hways can impai bladde and u e h al sensa ion (9).
4.2. Neu o-u ological consequences o b achy he apy o ce ical cance
Ionizing adia ion used in b achy he apy exe s i s cy o oxic e ec ia wo p ima y mechanisms: di ec induc ion o
DNA double-s and b eaks and indi ec oxida i e damage h ough adiolysis o wa e , gene a ing eac i e oxygen
species. While he he apeu ic a ge is malignan issue, adjacen pel ic o gans—including he bladde and u e h a—
a e a isk o colla e al inju y.
Radia ion-media ed deg ada ion o glycosaminoglycans comp omises he u o helial ba ie , inc easing pe meabili y
and exposing he subu o helium o ch onic in lamma o y s imuli. Acu e-phase changes include edema, mucosal
in lamma ion, nocicep i e ac i a ion, and de uso o e ac i i y. A e a a iable la en phase, p og essi e pe i ascula
ib osis, ischemia, smoo h muscle loss, and collagen in il a ion culmina e in la e adia ion sequelae such as adia ion
cys i is, educed cys ome ic capaci y, diminished compliance, u e h al o u e e al s ic u es, and sphinc e
insu iciency wi h u ina y incon inence (10).
U odynamic assessmen (UDA) is no ou inely indica ed o all pos - adio he apy LUTS, bu is ecommended o
pa ien s wi h symp oms e ac o y o conse a i e measu es, p io o an i-incon inence su ge y, o when uppe u ina y
ac de e io a ion is suspec ed. The mos equen ly obse ed pa e ns include de uso o e ac i i y, low compliance,
and educed u e h al closu e p essu es. Video-u odynamics—o al e na i ely, oiding cys ou e h og aphy combined
wi h p essu e- low s udies—a e aluable in de ec ing esicou e e al e lux ha may mask ele a ed de uso p essu es
du ing cys ome y (11).
4.3. Neu o-u ological consequences o mul iple scle osis
Lowe u ina y ac dys unc ion is p esen in he majo i y o indi iduals wi h mul iple scle osis (MS) and may mani es
ea ly in he disease cou se. Symp oms ypically eme ge a median o six yea s a e neu ological onse , bu can occu in
up o 10% o pa ien s a p esen a ion and in 80–90% o e he disease ajec o y (10–13).
LUTS in MS encompass bo h s o age and oiding symp oms. The mos p e alen a e u ina y u gency, inc eased day ime
equency, and u gency u ina y incon inence. Voiding phase dys unc ion—mani es ing as hesi ancy, s aining, weak
s eam, o incomple e emp ying—o en coexis s wi h s o age symp oms. Acu e u ina y e en ion occu s in up o 73%
o pa ien s a some s age. Senso y dis u bances, mos commonly bladde hyposensi i i y, a e epo ed in app oxima ely
75% o cases (15).
U odynamic p o iles a e he e ogeneous: de uso o e ac i i y is mos equen (median p e alence 65%), ollowed by
de uso unde ac i i y (25%) and educed compliance (2–10%). De uso –sphinc e dyssyne gia (DSD) is a iably
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epo ed (median 35%). No ably, he u odynamic pa e n may e ol e o e ime, independen o neu ological o
symp om s abili y (10–13).
4.4. Applica ion o he p esen clinical case
In he p esen pa ien , s o age phase abno mali ies may be a ibu ed o ei he MS- ela ed sup asac al lesions o
ia ogenic inju y o pel ic au onomic inne a ion om adical hys e ec omy. The oiding phase dys unc ion could
simila ly a ise om MS, pos -su gical neu ogenic sequelae, o pos - adio he apy ib o ic changes wi hin he bladde
ou le o u e h a.
5. Conclusion
Bladde and sphinc e diso de s a e highly p e alen in indi iduals wi h mul iple scle osis and in women who ha e
unde gone su gical ea men o ce ical cance , wi h o wi hou adju an pel ic adio he apy. These LUTD can in ol e
bo h he s o age and oiding phases, leading o a b oad spec um o symp oms such as u ina y u gency, equency,
u gency u ina y incon inence, oiding hesi ancy, o incomple e bladde emp ying. Beyond he conside able impac on
daily ac i i ies, social pa icipa ion, and emo ional well-being, hese symp oms may p og ess o cause uppe u ina y
ac de e io a ion i le un ea ed.
Ea ly iden i ica ion and comp ehensi e managemen o LUTD—in eg a ing a ge ed pha macological he apy, pel ic
loo ehabili a ion, in e mi en ca he e isa ion when indica ed, and, whe e app op ia e, su gical in e en ion—a e
essen ial o p ese e enal unc ion, main ain bladde heal h, and imp o e quali y o li e. Mul idisciplina y collabo a ion
be ween u ologis s, neu ologis s, ehabili a ion physicians, and pel ic loo he apis s is c i ical o op imise ou comes,
pa icula ly in complex cases whe e neu ological, oncological, and ia ogenic ac o s coexis .
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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Annexes
Annex 1: Flow measu emen
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Annex 2 : U odynamic es
Annex 3 : P o ilome y
