Pelvic Floor Dysfunction Following Gynecologic Cancer Surgery and Adjuvant Therapy: Epidemiology, Mechanisms, and Management-A Systematic Review

Abstract

Introduction and HypothesisThis systematic review synthesizes current evidence on the prevalence, risk factors, pathophysiology, clinical manifestations, and management of pelvic floor disorders (PFD) following gynecologic cancer surgery and adjuvant therapy, with an emphasis on rehabilitation, multidisciplinary care, and quality of life.MethodsFollowing PRISMA 2020 guidelines, PubMed, Embase, Scopus, and Web of Science were searched for English-language studies published between January 2000 and May 2025. Eligible studies included adult women with gynecologic malignancies reporting outcomes related to urinary or fecal incontinence, pelvic organ prolapse, chronic pelvic pain, or sexual dysfunction. Data were extracted using a standardized form, qualitatively synthesized, and the risk of bias was assessed using the Newcastle-Ottawa Scale.ResultsThirty studies met the inclusion criteria. PFD were highly prevalent, particularly after radical surgery and adjuvant therapies. Stress urinary incontinence and prolapse were more frequent after radical surgery, while urgency incontinence, vaginal stenosis, and chronic pelvic pain were linked to radiotherapy. Chemotherapy was associated with neurogenic bladder and bowel dysfunction. Independent risk factors included advanced age, obesity, and postmenopausal status. PFD significantly impaired physical, psychological, sexual, and social quality of life. Nerve-sparing and minimally invasive techniques showed promise in reducing dysfunction. Conservative measures-pelvic floor muscle training, biofeedback, vaginal dilators, and lifestyle modification-were effective for many patients, while surgical procedures such as slings and sacrocolpopexy were reserved for severe cases. Emerging options include local estrogen or DHEA after radiotherapy and onabotulinumtoxinA for refractory urge incontinence.ConclusionsPFD are underrecognized yet common and disabling complications in women treated for gynecologic cancers. Multidisciplinary management integrating pelvic floor rehabilitation and individualized survivorship care is essential to improve outcomes and quality of life. Further research should establish standardized screening, preventive strategies, and evidence-based rehabilitation protocols for this high-risk population.