Comparative Analysis of Bladder Function Return between Robotic Nerve-Sparing Radical Hysterectomy (C1 Hysterectomy) vs Robotic Non Nerve-Sparing Radical Hysterectomy (C2)

Objective:To investigate the bladder function recovery and quality of life (QOL) using nerve-sparing radical hysterectomy (NSRH) in treating early invasive cervical carcinoma.Methods:Subjects included patients who underwent radical hysterectomy by laparotomy for early-stage cervical carcinoma. Thirty-one patients were randomly assigned to 2 groups: group A, 15 patients who underwent NSRH; and group B, 16 patients who underwent classical radical hysterectomy. We observed the patients' general clinical information, surgical characteristics, postoperative vital signs, pathological findings, adjuvant therapies, and adverse effects. A urodynamic study was used to assess the bladder function. The patients' QOL was evaluated by Functional Assessment of Cervical Cancer Therapy (FACT-Cx).Results:Twenty-nine patients completed the study. No significant differences were found in age, body mass index, surgery characteristics, pathological findings, adjuvant therapies, and main adverse effects between the 2 groups (P > 0.05). The postoperative time of bladder function recovery in group A was obviously earlier than that in group B (P < 0.05). The urodynamic study showed that the extent of bladder function recovery in group A was better than that in group B (P < 0.05). The QOL in group A evaluated 1 year after operation was improved compared with that in group B (P < 0.05). The QOL analysis showed that group A did much better than group B in social and family life, emotional well-being, working status, and the symptom correlated with the operation (P < 0.05). No significant differences were found in basic bodily functions (P > 0.05).Conclusions:Nerve-sparing radical hysterectomy is a safe and reliable technique for early invasive cervical carcinoma. The postoperative bladder function recovery and the patients' QOL were improved after NSRH compared with the control group. Therefore, NSRH could be an alternative management to modify the classical surgery for cervical carcinoma with International Federation of Gynecology and Obstetrics stages IB1 to IIA.

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Risk Factors for Persistent Low Bladder Compliance After Radical Hysterectomy

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e318204c3df ◽

2011 ◽

Vol 21 (1) ◽

pp. 167-172 ◽

Cited By ~ 24

Author(s):

Yasunari Oda ◽

Yukiharu Todo ◽

Sharon Hanley ◽

Masayoshi Hosaka ◽

Mahito Takeda ◽

...

Keyword(s):

Risk Factors ◽

Radical Hysterectomy ◽

Bladder Function ◽

Autonomic Nerve ◽

Abdominal Pressure ◽

Nerve Sparing ◽

Autonomic Nerves ◽

Adjuvant Radiation ◽

Management Protocol ◽

Bladder Compliance

Introduction:Bladder compliance deteriorates immediately after radical hysterectomy (RH), and low bladder compliance causes upper urinary tract dysfunctions such as progressive hydronephrosis. The aims of this study were to clarify risk factors for persistent low bladder compliance after RH and to propose a postsurgical management protocol for improved recovery of bladder function.Methods:A total of 113 consecutive patients who underwent RH with the intention to preserve the pelvic autonomic nerve system were included in this prospective study. Urodynamic studies were performed according to a planned schedule: presurgery and 1, 3, 6, and 12 months after surgery. Autonomic nerves were preserved at least unilaterally in 95 (84.1%) of the 113 patients, but this was not possible in the remaining 18 patients (15.9%). Postoperative adjuvant radiation therapy (RT) was performed in 14 patients. The relationships between bladder compliance and various clinical factors were investigated using logistic regression analysis. Covariates included age, nerve-sparing procedure, adjuvant RT, and maximum abdominal pressure during the voiding phase. Bladder compliance at 12 months after surgery was used as the dependent variable.Results:Radical hysterectomy with a non-nerve-sparing procedure (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-11.0), adjuvant RT (OR, 10.3; 95% CI, 2.5-43.5), and voiding with abdominal pressure at 3 months after surgery (OR, 2.9; 95% CI, 1.1-7.2) were risk factors for persistent low bladder compliance.Conclusions:A nerve-sparing procedure and prohibition of voiding with abdominal strain during the acute and subacute phases after RH resulted in improved recovery of bladder compliance. Adjuvant RT should be avoided in patients who undergo nerve-sparing RH if an alternative postoperative strategy is possible.

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Success Factors of Laparoscopic Nerve-sparing Radical Hysterectomy for Preserving Bladder Function in Patients with Cervical Cancer: A Protocol-Based Prospective Cohort Study

Annals of Surgical Oncology ◽

10.1245/s10434-014-4197-1 ◽

2014 ◽

Vol 22 (6) ◽

pp. 1987-1995 ◽

Cited By ~ 16

Author(s):

Hee Seung Kim ◽

Tae Hun Kim ◽

Dong Hoon Suh ◽

Sang Youn Kim ◽

Min A. Kim ◽

...

Keyword(s):

Cervical Cancer ◽

Cohort Study ◽

Prospective Cohort Study ◽

Radical Hysterectomy ◽

Prospective Cohort ◽

Success Factors ◽

Bladder Function ◽

Nerve Sparing

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Nerve Sparing Radical Hysterectomy: Short-Term Oncologic, Surgical, and Functional Outcomes

Cancers ◽

10.3390/cancers12020483 ◽

2020 ◽

Vol 12 (2) ◽

pp. 483 ◽

Cited By ~ 3

Author(s):

Mustafa Zelal Muallem ◽

Robert Armbrust ◽

Jörg Neymeyer ◽

Andrea Miranda ◽

Jumana Muallem

Keyword(s):

Radical Hysterectomy ◽

Locally Advanced ◽

Complete Recovery ◽

Bladder Function ◽

Oncologic Outcomes ◽

Autonomic Nerve ◽

Nerve Sparing ◽

Short Term ◽

Locally Advanced Tumors ◽

Advanced Tumors

There is an obvious prevalence of disparity in opinions concerning the technique of nerve-sparing radical hysterectomy and its application, despite agreement on the need to spare the pelvic autonomic nerve system during such a radical operation. Understanding the precise three-dimensional anatomy of paracolpium and its close anatomical relationship to the components of the pelvic autonomic nervous system is the key in performing the nerve-sparing radical hysterectomy. A total of 42 consecutive patients with primary cervical cancers, who were operated upon in our institution between January 2017 and June 2019, were analyzed, concerning surgical, urinary functional, and short-term oncologic outcomes. Two thirds of the patients had locally advanced tumors (T > 40 mm or pT ≥ IIA2) with a median tumor size of 44.1 mm. The nerve-sparing radical hysterectomy was combined with the complete recovery of bladder function in 90% of patients directly after surgery and in 97% of patients in the first 2 weeks. The recurrence rate in a median follow-up time of 18 months was 9.5%. The nerve-sparing radical hysterectomy approach, which depends on the comprehensive understanding of the precise entire anatomy of paracolpium, was found to be feasible and applicable, even in locally advanced tumors, with good functional results and convincing short-term oncologic outcomes.

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A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200503000-00035 ◽

2005 ◽

Vol 15 (2) ◽

pp. 389-397 ◽

Cited By ~ 19

Author(s):

N. Sakuragi ◽

Y. Todo ◽

M. Kudo ◽

R. Yamamoto ◽

T. Sato

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Invasive Cervical Cancer ◽

Uterine Cervical Cancer ◽

Bladder Function ◽

Autonomic Nerve ◽

Nerve Sparing ◽

Autonomic Nerves ◽

Bladder Sensation ◽

Pelvic Splanchnic Nerves

The objective of this study is to describe a technique for preserving the autonomic nerve systematically, including the hypogastric nerves, pelvic splanchnic nerves, and pelvic plexus and its vesical branches, based on anatomic considerations for the autonomic nerves innervating the urinary bladder, in radical hysterectomies and to assess postsurgical bladder function. A nerve-sparing radical hysterectomy was carried out on 27 consecutive patients with uterine cervical cancer treated between 2000 and 2002. The FIGO stages of the disease consisted of 10 stage Ib1, 6 stage Ib2, 3 stage IIa, and 8 stage IIb. The nerve-sparing procedure was successfully completed in 22 of the 27 patients (81.5%) in the study. At 1 year after the operation, bladder symptoms were significantly improved in the nerve-sparing group compared to the non–nerve-sparing group. Urinary incontinence and abnormal (diminished) bladder sensation were observed in three of the five patients (two patients had both symptoms), for whom the nerve-sparing procedure could not be performed, but none of the 22 patients for whom the nerve-sparing procedure was performed had incontinence, and only two patients had abnormal (increased) bladder sensation (P = 0.0034 for incontinence and P = 0.030 for abnormal bladder sensation). The patients' survival was not adversely affected by the nerve-sparing procedure. Although it is still preliminary, the surgical technique described in this report is thought to be effective for preserving bladder function, and thus, the quality of life could be improved for patients with cervical cancer who are treated with a radical hysterectomy. For further evaluation of the efficacy of nerve-sparing radical hysterectomy, a prospective randomized trial needs to be performed.

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