Multidimensional assessment of urinary dysfunction and quality of life after cervical cancer treatment: a multicenter study integrating urodynamics and patient-reported outcomes

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Background: Cervical cancer treatment may result in long-term urinary dysfunction and impaired quality of life. However, studies integrating objective urodynamic findings with patient-reported outcome measures (PROMs) remain limited. This study evaluated urinary function, quality of life, sexual function, fatigue, and psychological well-being in women treated for cervical cancer, with particular emphasis on treatment modality. Methods: This multicenter observational study included 132 women, comprising patients treated with surgery alone (S; n = 15), surgery followed by adjuvant therapy (S+A; n = 53), definitive radiotherapy with or without chemotherapy (R; n = 26), and a control group without a history of gynecological malignancy (C; n = 38). Baseline assessments were performed before treatment initiation, with follow-up evaluations at 3, 6, and 9 months after treatment completion. Urogynecological evaluation included urodynamic testing and classification of urinary dysfunction, while patient-reported outcomes were assessed using the Incontinence Impact Questionnaire-7 (IIQ-7), Urogenital Distress Inventory-6 (UDI-6), Satisfaction With Life Scale (SWLS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Hospital Anxiety and Depression Scale (HADS), and Female Sexual Function Index (FSFI). Results: Urinary dysfunction was a frequent complication and became more pronounced during follow-up, particularly among women receiving radiotherapy. The proportion of patients with normal bladder function progressively decreased, accompanied by an increase in overactive bladder and mixed urinary incontinence. Objective urodynamic findings generally indicated reduced bladder capacity, lower maximum urinary flow rate, increased post-void residual volume, and a higher prevalence of detrusor overactivity among women treated with radiotherapy. Pain intensity, fatigue, anxiety and depressive symptoms increased over time, whereas life satisfaction and sexual function deteriorated, particularly in patients receiving radiotherapy or combined treatment. Weak but statistically significant correlations were observed between urodynamic findings and patient-reported outcomes, suggesting limited concordance between objective and subjective measures of urinary dysfunction. Conclusions: Cervical cancer treatment, particularly radiotherapy, is associated with persistent urinary dysfunction and deterioration in quality of life, fatigue, psychological well-being, and sexual function. Combining urodynamic assessment with patient-reported outcomes provides a more comprehensive evaluation of treatment-related morbidity and may facilitate earlier identification of patients requiring supportive care.

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