NERVE SPARING« RADICAL HYSTERECTOMY – PREVENTION OF POST-OPERATIVE URINARY TRACT DYSFUNCTION
Abstract
Background. Radical hysterectomy is performed on woman with cervical cancer or endometrial cancer that has spread to the cervix.
Aims. To find whether our modified radical hysterectomy represents nerve sparing.
Methods. In 28 patients, modified radical hysterectomy was applied (study group) and the width of the parametria and vaginal cuff were measured. Using a point-counting technique, nerve areal density was determined in cross sections of resected parametria at 0.5 cm (A), 1 cm (B), and 1.5 cm (C) from the cervix. The results were compared with 26 control patients who underwent classic radical hysterectomy. In the study group urodynamic measurements were performed after operation, and correlations with histologic data were calculated. The survival rates and adjuvant treatment were compared between the groups.
Results. Adjuvant treatment was given to 53.57 % in the study and 65.38 % of patients in the control group (P > 0.3). The survival rate after 3 years was 92.85 % in the study and 84.61 % in the control group after more than 5 years. The width of the resected parametria was smaller in the study (mean: right 15.50 mm, left 15.71 mm) compared with the control group (mean: right 22.69 mm; P < 0.013; left 22.96 mm; P < 0.011). The nerve areal density in the lateral part of the right parametrium (C right 6.2 %) was lower in the study than in the control group (C right 9.7 %; P < 0.01). There were several correlations between parametrial width, nerve areal density and urodynamic parameters.
Conclusions. Modified radical hysterectomy is less radical, and apparently also nerve sparing. It does not influence survival rates and does not impair the urinary tract function.
Downloads
References
Low JA, Mauger GM, Carmichael JA: The effect of Wertheim
hysterectomy upon bladder and urethra function. Am J Obstet
Gynecol 1981; 139: 826–34.
Seski JC, Dioknu AC: Bladder dysfunction after radical abdominal
hysterectomy. Am J Obstet Gynecol 1977; 128: 643–51.
Ralph G, Tamussino K, Lichtenegger W. Urological complications
following radical abdominal hysterectomy for cervical cancer.
Arch Gynecol Obstet 1988; 243: 215–20.
Todo Y, Kuwabara H, Watari H, Ebina Y, Takeda M, Kudo M,
Yamamoto R, Sakuragi N. Urodynamic study on postsurgical
bladder function in cervical cancer treated with systematic
nerve-sparing radical hysterectomy. Int J Gynecol Cancer 2006;
: 369–75.
Scotti RJ, Bergman A, Bhatia NN, Ostergard DR. Urodynamic
changes in urethrovesical function after radical hysterectomy.
Obstet Gynecol 1986; 68: 111–20.
Farquarson DI, Shingelton HM, Soong SG, Scanford SP, Levy DS,
Hatch KD. The adverse effect of cervical cancer treatment on
bladder function. Gynecol Oncol 1987; 27: 15–23.
Ralph G, Winter R, Michelitsch L, Tamussino K. Radicality of
parametrial resection and dysfunction of the lower urinary
tract after radical hysterectomy. Eur J Gynecol Oncol 1991; 12:
–30.
Possover M, Stőber S, Plaul K, Schneider A. Identification and
Preservation of the Motoric Innervation of the Bladder in Radical
Hysterectomy Type III. Gynecol Oncol 2000; 79: 154–7.
Possover M, Schneider A. Slow-transit constipation after radical
hysterectomy type III (Anatomic-based explanation and prevention).
Surg Endosc 2002; 16: 847–50.
Possover M, Rheim K, Chiantera V. The »Laparoscopic NeuroNavigation«
– LANN: from a functional cartography of the pelvic
autonomus neurosystem to a new field of laparoscopic surgery.
Min Invas Ther Allied Technol 2004; 13: 362–7.
Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Kitamura S.
Dissection of the cardinal ligament in radical hysterectomy for
cervical cancer with emphasise on the lateral ligament. Am J
Obstet Gynecol 1991; 164: 7–14.
Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Satou N. A new
proposal for radical hysterectomy. Gynecol Oncol 1996; 62:
–8.
Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Nishikawa Y,
Nakajima T. Radical Hysterectomy: An Anatomical Evaluation
of Parametrial Dissection. Gynecol Oncol 2000; 77: 155–63.
Sakuragi N, Todo Y, Kudo M, Yamamoto R, Sato T. A systematic
nerve-sparing radical hysterectomy in invasive cervical cancer for
preserving postsurgical bladder function. Int J Gynecol Cancer
; 15: 389–97.
DiStefano AB, Alboni C, Garozzo G, Barbič M, Rakar S, Kobal B,
et al. Nerve contents of the deep part of anterior parametrium:
an anatomic study. In: Abstract of the 15th International Meeting
of the European Society of Gynaecological Oncology (ESGO);
Oct 28 Nov 1; Berlin. Berlin: European Society of Gynaecological
Oncology, 2007.
Incidenca raka v Sloveniji 2005. Ljubljana: Onkološki inštitut
Ljubljana, Register raka za Slovenijo; 2008.
Burghardt E, Pickel H. Local spread and lymph node involvement
in cervical cancer. Obstet Gynecol 1978; 52: 138–45.
Burghardt E, Pickel H, Haas J, Lahousen M. Prognostic factors
and operative treatment of stages IB to IIB cervical cancer. Am
J Obstet Gynecol 1987; 156: 988–96.
Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Cutillo
G, D’Andrea G et al. Lymphatic spread of cervical cancer: an
anatomical and pathological study based on 225 radical hysterectomies
with systematic pelvic and aortic lymphadenectomy.
Gynecol Oncol 1996; 62: 19–24.
Sironi S, Belloni C, Taccagni GL, Del Maschio A. Carcinoma of
the cervix: Value of MR imaging in detecting parametrial involvement.
Am J Roentgen 1991; 156: 753–6.
Lien HH, Blomlie V, Iversen T, Trope C, Sundford K, Abeler VM.
Clinical stage I carcinoma of the cervix. Value of the MR imaging
in determining invasion into the parametrium. Acta Radiol 1993;
: 130–2.
DeSouza NM, Hawley IC, Schwieso JE, Gilderdale DJ, Soutter WP.
The uterine cervix on in vitro and in vivo MR images: a study
of zonal anatomy and vascularity using an enveloping cervical
coil. Am J Roentgen 1994; 163: 607–12.
Hagen B, Shepherd JH, Jacobs IJ. Parametrial resection for invasive
cervical cancer. Int J Gynecol Cancer 2000; 10: 1–6.
Trimbos JB, Maas CP, Deruiter MC, Peters AAW, Kenter GG. A
nerve-sparing radical hysterectomy: guidelines and feasibility
in Western patients. Int J Gynecol Cancer 2001; 11: 180–6.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
