Bladder Dysfunction After Radical Hysterectomy: The Role of Tailoring Parametrectomy and Nerve Sparing Surgery in Early Cervical Cancer (Stage IA-IIA FIGO) (original) (raw)

Introductionː the availability of screening and the existence of a specific diagnostic and therapeutic process has favored early diagnosis of cervical cancer. Performing radical hysterectomy (RH) (type III Piver or type C2 Querleu), pelvic nerves and fascial structures can be interrupted in the anterior, posterior and lateral parametrium, leading to various degrees of bladder dysfunction. In literature, various studies have found that the reduction of radicality on parametria in early cervical cancer (ECC) leads to lower complications rate, without influencing oncological outcomes. Unfortunately, only few data are now disposable, and evidences are not so clear. The aim of our review is to evaluate how "less radical surgery" on parametria and NSRH (Nerve Sparing Radical Hysterectomy), in the specific population of ECC, could impact on bladder function, comparing it with a more radical approach. Material and Methods: Searching on Pubmed, we included 1473 articles published from January 1974 to September 2020. We identified all studies that compared different techniques of radical hysterectomy as primary surgical treatment of ECC. Then, we focused our analysis on bladder functionality after surgical treatment: 10 articles were included in our review. Result: Radical hysterectomy Piver II/Querleu-Morrow Type B in ECC, if compared to classic radical hysterectomy (Piver III/Querleu-Morrow Type C2), is associated with minor bladder dysfunction. Nerve sparing radical hysterectomy approach (NSRH/ Querleu-Morrow Type C1) compared to CRH (Piver III/Type C2) in the ECC, seems to give a better urologic outcome after surgery. Conclusionsː Reduced radicality on the parametrium in the specific population of ECC (stages IA-IIA FIGO) offers positive effects on patients' bladder function.