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Summary Radical abdominal hysterectomy for cervical cancer is naturally associated with a number of urological complications. In a review of 320 hospital records we found a 6.6% incidence of intraoperative injury to the bladder or ureters; in all cases the tumour had encroached on the organ. The incidence of postoperative fistula formation was 4.4%. Postoperative urodynamic studies of 116 patients after radical hysterectomy, with or without adjuvant radiotherapy, quantified lower urinary tract dysfunction. A prospective study of 40 patients showed that 20% developed urinary stress-incontinence after surgery. Patients who had had surgery only showed an improvement in most urodynamic parameters over the years, while patients who had also had radiotherapy did not. Seventy-eight per cent of the patients after surgery only were satisfied with their condition and, years later, reported no complaints. They may just have become used to them, but half the patients who had also had radiotherapy reported complaints, mainly impaired bladder sensation, frequency and nocturia. Urinary tract dysfunction after radical hysterectomy is inevitable, but meticulous peri-operative management, regular follow-up examinations and psychological support can keep it to a minimum and help the patient to cope.

BackgroundOptimizing and ensuring the quality of surgical care is essential to improve the management and outcome of patients with cervical cancer.To develop a list of quality indicators for surgical treatment of cervical cancer that can be used to audit and improve clinical practice.MethodsQuality indicators were developed using a four-step evaluation process that included a systematic literature search to identify potential quality indicators, in-person meetings of an ad hoc group of international experts, an internal validation process, and external review by a large panel of European clinicians and patient representatives.ResultsFifteen structural, process, and outcome indicators were selected. Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are also detailed to define how the indicator will be measured in practice. Each indicator has a target which gives practitioners and health administrators a quantitative basis for improving care and organizational processes.DiscussionImplementation of institutional quality assurance programs can improve quality of care, even in high-volume centers. This set of quality indicators from the European Society of Gynaecological Cancer may be a major instrument to improve the quality of surgical treatment of cervical cancer.