Evaluation of pelvic visceral functions after modified nerve-sparing radical hysterectomy

Background Nerve-sparing radical hysterectomy (NSRH) was developed in an attempt to minimize complications after radical hysterectomy. Since 2008, a modified NSRH-nerve plane-sparing radical hysterectomy (NPSRH) has been developed at the Cancer Hospital, Chinese Academy of Medical Sciences. The aim of this study was to investigate the role of NPSRH in improving postoperative pelvic visceral dysfunctions.

Methods Eighty-three patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA2 cervical cancer received NPSRH (the study group) from January 2008 to October 2012. One hundred and sixty-six patients who underwent conventional radical hysterectomy (CRH) were randomly selected as the control group. Age, pathological type and stage were matched between the two groups. The safety of surgery was assessed by duration of operation and blood transfusion rate. Postoperative short-term bladder function was analyzed by duration of catheterization. Long-term bladder, anorectal and sexual function were evaluated with questionnaires.

Results Seventy-eight patients (94.0%) in the NPSRH group and one hundred and sixty patients (96.4%) in the CRH group completed the study. Median follow-up time was 31.9 months and 31.0 months respectively (P=0.708). There was no significant difference between the two groups in terms of age, body mass index, FIGO stage, pathologic type, preoperative and postoperative therapy (P >0.05). The blood transfusion rate shared no difference between two groups (P=0.364). The operation time in the NPSRH group was significantly longer than CRH group (P <0.01). But the duration of catheterization and hospitalization in the NPSRH group was significantly reduced compared with CRH group (P <0.01). In addition, the incidence of long-term urinary frequency, urinary incontinence, urinary retention, straining to void, constipation and diarrhea was significantly lower in the NPSRH group (P <0.05). However, there was no significant difference regarding sexual function (P >0.05).

Conclusions The current evidence indicated that NPSRH improved long-term bladder function compared to CRH. Moreover, it may improve long-term anorectal function as well.