The more extensive a surgical procedure in a small pelvis, the higher the risk for the lower urinary tract with its nerve supply and nerve plexus. This concerns mainly the sympathetic chains, the parasympathetic structures and, rarely, the visceral supply of the pelvic floor. Direct trauma to the bladder and its vascular supply as well as indirect injury by displacement of the bladder need to be seriously considered. Problems with micturition and impaired storage capacity of the bladder are the result. Complete urodynamic examination and follow-up can help in differentiating between temporary and persisting disturbances and in taking therapeutical decisions. The most evident @entity260 is disturbed micturition, managed initially by suprapubic urinary diversion, followed as soon as possible by intermittent self-catheterisation. This is the only way to avoid overstretching of the bladder, recurring @entity293 and damage to the upper urinary tract. Restoration of spontaneous micturition can be supported by drug treatment with parasympatholytics and/or alpha-blockers if the measured bladder pressure and residual urine are within tolerable limits. For electrostimulation of micturition, intravesical therapy, although timeconsuming, is best suited because it can easily be done on an outpatient basis. More promising seems bilateral sacral neuromodulation, which, however, is a rather complicated and expensive procedure. Surgical procedures to reduce the voiding resistance of the bladder involve the risk of @entity86 because the sphincter function in those @entity1 is often disturbed too. Persisting problems with bladder storage capacity as a result of @entity5 surgery in the small pelvis are frequently secondary to retention of urine (overflow @entity322 ). In these cases, regular evacuation of the bladder by intermittent self-catheterisation can lead to social acceptance. Reduced bladder compliance and lowering of the urethral leak pressure point may result in stress and urge @entity322 , which, according to the established rules, should be managed by physiotherapy and behaviour therapy as well as drug therapy and only in exceptional cases by surgical measures. Prevention of postoperative @entity1494 can be tried by tissue- and nerve-sparing surgical techniques, but is always determined by oncological aspects.

[ XXXX and surgery in the small pelvis. Therapeutic possibilities].

@entity1 :: ('9606', 'Species') :: ['patients'] @entity322 :: ('MESH:D014549', 'Disease') :: ['incontinence'] @entity1494 :: ('MESH:D001745', 'Disease') :: ['bladder dysfunction'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity260 :: ('MESH:D011183', 'Disease') :: ['postoperative complication'] @entity86 :: ('MESH:D019106', 'Disease') :: ['postoperative incontinence'] @entity293 :: ('MESH:D014552', 'Disease') :: ['urinary tract infection']
@entity1494 :: (MESH:D001745,Disease) :: ['Bladder dysfunction']
