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Bladder function after radical hysterectomy for cervical cancer

Authors


  • Mickey Karram led the peer-review process as the Associate Editor responsible for the paper.
  • Conflict of interest statement: Francisco Cruz declares financial relationship with Astellas, Allergan, Pfizer, Recordati. Chistopher Chapple declares to serve as a consultant to AMS and Lilly, consultant and researcher to ONO, consultant, researcher and speaker for Allergan, Astellas, Pfizer and Recordati. The remaining authors declare no conflicts of interest related to this manuscript.
  • Each authors' contribution to the manuscript: Rosa M. Laterza: conception of the draft, literature analysis, writing and editing the manuscript. Karl-D. Sievert, Dirk de Ridder, Mark E. Vierhout, Francois Haab, Linda Cardozo, Philip van Kerrebroeck, Francisco Cruz, Con Kelleher, Christopher Chapple, Montserrat Espuña-Pons: draft design, literature analysis, and manuscript editing.
  • Heinz Koelbl: draft design, literature analysis, manuscript editing, approval of the final version.

ABSTRACT

Aim

To report the effects of radical hysterectomy and nerve-sparing techniques on lower urinary tract function in women.

Methods

A literature search was performed in Pubmed and Medline using the keywords bladder after radical hysterectomy, nerve sparing radical hysterectomy, and urinary dysfunction following radical hysterectomy. Significant results and citations were reviewed manually by the authors.

Results

The sympathetic and parasympathetic systems innervating the lower urinary tract may be disrupted due to resection of uterosacral and rectovaginal ligaments, the dorsal and lateral paracervix, the caudal part of the vesico-uterine ligaments, and the vagina. This supports the neurogenic etiology of early and late bladder dysfunction after radical surgery. Bladder disorders are also related to the extent of radical surgery. The neuropathopysiology of lower urinary tract symptoms after radical hysterectomy is not fully understood. Recent data have highlighted the role of urethral sphincter pressure in the etiology of postoperative incontinence. Various surgical approaches have been developed to preserve autonomic pelvic innervation.

Conclusions

Nerve-sparing techniques appear to improve bladder function without compromising overall survival. Studies comparing the effects of nerve-sparing radical hysterectomy with standard surgery yielded encouraging results in respect of postoperative lower urinary tract function. Clinical trials with a long period of follow-up are required for better comprehension of the complex pathophysiology of bladder dysfunction after radical hysterectomy. Neurourol. Urodynam. 34:309–315, 2015. © 2014 Wiley Periodicals, Inc.

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