Bladder Dysfunction After Radical Hysterectomy: The Role of Tailoring Parametrectomy and Nerve Sparing Surgery in Early Cervical Cancer (Stage IA-IIA FIGO) (original) (raw)
2020, Biomedical Journal of Scientific & Technical Research
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.
Sign up to get access to over 50M papers
Sign up for access to the world's latest research
Related papers
A prospective study of nerve-sparing radical hysterectomy for uterine cervical carcinoma in Taiwan
Taiwanese Journal of Obstetrics & Gynecology, 2012
Objective: Surgical therapy for cervical carcinoma carries a significant risk of functional impairment to the bladder. This study evaluates the feasibility and complications of nerve-sparing radical hysterectomy (NRH) in Taiwan. Methods: Between March 2010 and March 2011, consecutive patients diagnosed with early stage cervical cancer (FIGO stage Ia2 to Ib1) and tumor size < 3 cm were recruited prospectively to undergo NRH or conventional radical hysterectomy (RH). Patients with histories of urinary stress incontinence or bladder dysfunction disease were excluded. A modified Tokyo nerve-sparing radical hysterectomy was performed. Results: A total of 30 patients were enrolled. Among these, 18 patients underwent NRH with successful bilaterally nerve-sparing procedures in 15 cases (83%), unilaterally nerve-sparing procedures in 2 cases (11%), and a failure in 1 case (6%). The indwelling catheter was removed on postoperative day 6. The mean AE SD duration from operation to spontaneous voiding was 6.8 AE 1.5 days for women who underwent NRH; the corresponding duration for women who underwent RH or failed NRH was 20.6 AE 3 days. None of the patients who underwent NRH required intermittent catheterization. All 12 patients who underwent RH needed self-catheterization after discharge. There was a significant reduction in the incidence of postoperative self-catheterization (p < 0.01) and bladder dysfunction (p < 0.006). Average satisfaction score analyzed by the Likert-scale questionnaire was 4.5 for the NRH group and 1.9 for RH group (p < 0.0001). Conclusions: We concluded that the new technique of NRH can reduce postoperative bladder dysfunctions.
International Urogynecology Journal, 1991
Lower urinary tract function was evaluated by means of clinical and urodyfiamic assessment in a prospective randomized study including 31 patients undergoing two different types of extended hysterectomy [1] for cervical cancer. In the immediate postoperative period loss of both bladder sensitivity and detrusor voiding activity with reduced compliance was observed in 60% of patients regardless of the operative procedure performed. At 3 months follow-up, the improvement in urethrovesical function was significantly related to a less extensive dissection of pelvic connective tissue (P<0.01).
Annals of surgical oncology, 2014
Success factors of laparoscopic nerve-sparing radical hysterectomy (LNRH) to preserve bladder function are little known despite its widespread use. Thus, we conducted a protocol-based prospective cohort study to evaluate clinicopathologic factors for preserving autonomic nerves and its impact on duration of postoperative catheterization (DPC). From 2012 to 2014, 30 patients with stage IB1 to IIA2 cervical cancer were recruited prospectively to undergo LNRH. All procedures were performed on the left side of the patients by one gynecologic oncologist. Extent of resection and preservation of autonomic nerves were documented in the protocol during LNRH. All patients received laparoscopic type C1 radical hysterectomy, where extent of resection and preservation of autonomic nerves were not different between the right and left sides. Stage IB1 disease was associated with the reduced risk of injury of the left junctions between the hypogastric and the splanchnic nerves; between the splanchn...
Feasibility and Functional Outcome of Laparoscopic Nerve Sparing Radical Hysterectomy
Zagazig university medical journal, 2018
Aim: Evaluation of the feasibility of laparoscopic nerve sparing radical hysterectomy in comparison to the nonnerve sparing type. Methodology:Patient recruitment started from November 2014 to November 2016, patients who underwent laparoscopic type C1 hysterectomy and laparoscopic type C2 hysterectomy according to Querleu-Morrow classification(1) at our departments were prospectively evaluated. The inclusion criteria included: Patients with cervical carcinoma Stage IA2 to stage IIB cervical cancer according to FIGO staging and Stage II-III endometrial cancer with cervical involvement according to FIGO staging. Postoperative drainage of the bladder through a Foley catheter was maintained for 2 days and removed on the third day and the patients were asked to perform spontaneous voiding every 3 hours followed immediately by drainage of the bladder by urinary catheter to assess the post void residual (PVR) urine volume. The procedure was repeated until the PVR is less than 100 ml. The voiding function was considered normal when the patient had 2 consecutive measurements of PVR urine less than 100 ml and abnormal if the patient had a PVR urine more than 100 ml with need of self-catheterization after 4 weeks from the date of surgery. Results:46 patients were included in the study, 30 patients underwent type C1 LNSRH (Group A) and 16 patients underwent type C2 LRH (Group B). The mean age was 49.1±13.1 and 51.2±11.8, median BMI was 26.2(22.9-28.5) and 23.8(21-26.6) respectively for the 2 groups. The mean operative time was 240.1±65.5 in group A and 308.1±83 in group B (P value=0.004). The rate of intraoperative complications was 10% in group A and 12.5% in group B. The median duration of postoperative catheterization until the PVR urine volume was less than 100 ml was 3.5(3-5) days in group A and 6(4-8.5) days in group B (P value=0.002), The rate of late postoperative complications including bladder dysfunction was 3.3% (Group A) and 31.25% (Group B) (P value 0.002). Conclusion:Our study results supported the feasibility of LNSRH technique with better functional outcome without compromising the oncologic safety of the procedure
International Journal of Gynecological Cancer, 2006
The objectives were to describe our nerve-sparing class III radical hysterectomy technique and assess the feasibility and safety of the procedure as well as its impact on voiding function. From January to August 2005, 21 consecutive patients with FIGO stage IB-IIA cervical cancer and 1 patient with clinical stage II endometrial cancer underwent nerve-sparing radical hysterectomy with systematic pelvic lymphadenectomy. The transurethral catheter was removed on the seventh postoperative day. Then intermittent self-catheterization was performed and post-void residual urine volume (PVR) was recorded. The nerve-sparing procedure was completed successfully and safely in all of the patients. Eight (36%) and 6 (27%) patients had the PVR of < 100 ml and < 50 ml respectively at the initial removal of the catheter. On the fourteenth day, 82% and 77% of the patients had the PVR of < 100 ml and < 50 ml, respectively. The mean duration before the PVR became < 50 ml was 11.27 (5-26) days. In conclusion, the technique described in this preliminary study appears safe, adequate, and feasible in our population with satisfactory recovery of voiding function. A larger comparative study is needed on long-term urinary, bowel, and sexual function as well as recurrence and survival.
Journal of Gynecologic Oncology, 2019
Objectives: Nerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes. Methods: Data of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied. Results: Thirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p<0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test). Conclusion: Laparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.
A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients
International Journal of Gynecological Cancer, 2002
Surgical damage to the pelvic autonomic nerves during radical hysterectomy is thought to be responsible for considerable morbidity, i.e., impaired bladder function, defecation problems, and sexual dysfunction. Previous anatomical studies and detailed study of surgical techniques in various Japanese oncology centers demonstrated that the anatomy of the pelvic autonomic nerve plexus permits a systematic surgical approach to preserve these nerves during radical hysterectomy without compromising radicality. We introduced elements of the Japanese nerve-preserving techniques and carried out a feasibility study in ten consecutive Dutch patients. The technique involved three steps: first, the identification and preservation of the hypogastric nerve in a loose tissue sheath underneath the ureter and lateral to the sacro-uterine ligaments; second, the inferior hypogastric plexus in the parametrium is lateralized and avoided during parametrial transsection; third, the most distal part of the inferior hypogastric plexus is preserved during the dissection of the posterior part of the vesico-uterine ligament. The clinical study showed that the procedure is feasible and safe, except possibly when used with very obese patients and patients with broad, bulky tumors. Surgical preservation of the pelvic autonomic nerves in radical hysterectomy deserves consideration in the quest to improve both cure and quality of life in cervical cancer patients.
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.