Voiding recovery after radical parametrectomy in cervical cancer patients: An international prospective multicentre trial – SENTIX

Zapardiel, Ignacio; Kocián, Roman; Köhler, C; Klát, Jaroslav; Germanová, Anna; Jacob, Anna; Bajsová, Sylva; Böhmer, Gerd; Lay, Laura; Gil-Ibáñez, Blanca; Havelka, P; Kipp, Barbara; Szewczyk, Grzegorz; Tóth, Róbert; Staringer, Juan Carlos; Santiago, Javier De; Coronado, Pluvio; Póka, Ròbert; Laky, R; Luyckx, Mathieu; Fastrez, Maxime; Dušek, Ladislav; Hernández, Alicia; Cibula, David

doi:10.1016/j.ygyno.2020.12.018

Cited by 10 publications

(13 citation statements)

References 16 publications

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“…Our results are consistent with previous retrospective studies demonstrating the overall safety of early catheter removal after radical hysterectomy 16–21. Despite using various definitions of early urinary catheter removal and voiding dysfunction, these studies have demonstrated overall that urinary catheter removal <72 hours postoperatively results in voiding dysfunction rates between 17–44% 16–18 20.…”

Section: Discussionsupporting

confidence: 91%

“…Despite the advantages of nerve-sparing surgery, there remains significant debate regarding the duration of urinary catheterization in patients who undergo radical hysterectomy, and practice patterns vary widely among gynecologic oncologists 16. Recent evidence suggests that early catheter removal may be appropriate in patients undergoing radical hysterectomy16–21; however, the interpretation of these studies in contemporary practice is limited by small numbers of patients undergoing open surgery on enhanced recovery after surgery (ERAS) pathways 22…”

Section: Introductionmentioning

confidence: 99%

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Impact of timing of urinary catheter removal on voiding dysfunction after radical hysterectomy for early cervical cancer

Huepenbecker

Santía

Harrison

et al. 2022

Int J Gynecol Cancer

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ObjectivesTo evaluate whether the timing of postoperative urinary catheter removal is associated with voiding dysfunction after radical hysterectomy for early cervical cancer within contemporary surgical practice.MethodsWe performed an institutional retrospective cohort study of patients who underwent Piver type II-III open or minimally invasive radical hysterectomy for early-stage cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1 with lymphovascular invasion to stage IIA) between January 2006 and December 2019. We compared voiding dysfunction (inability to spontaneously void with a post-void residual <100 mL after catheter removal) and outcomes based on postoperative timing of urinary catheter removal using univariate and multivariate logistic regressions.ResultsAmong 234 patients, 86 (36.8%) underwent open surgery and 112 (47.9%) used enhanced recovery after surgery (ERAS) pathways. 29 (12.4%) patients had urinary catheter removal between 1–5 days postoperatively (group 1), 141 (60.3%) between 6–10 days (group 2), and 64 (27.3%) between 11–15 days (group 3). The overall rate of voiding dysfunction was 11.5%, with no difference between group 1 (17.2%), group 2 (11.3%), and group 3 (9.4%) (p=0.54). Group 1 had a significantly shorter time from surgery to spontaneous voiding (4 days, IQR 3–5 days) compared with group 2 (8 days, IQR 7–10 days) and group 3 (13 days, IQR 11–15 days) (p<0.01). There was no difference in hospital length of stay, urinary tract infection, or re-admission due to a genitourinary complication within 60 days of surgery based on timing of catheter removal. On multivariate analysis, the odds of voiding dysfunction did not differ by tumor size, type of hysterectomy, cancer stage, surgical approach, ERAS timeframe, or timing of catheter removal group.ConclusionThere was no difference in voiding dysfunction or postoperative genitourinary complications based on timing of urinary catheter removal after radical hysterectomy. Early catheter removal should be considered in this population.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Impact of timing of urinary catheter removal on voiding dysfunction after radical hysterectomy for early cervical cancer

Huepenbecker

Santía

Harrison

et al. 2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…In addition, RH, which involves treatment of para-connective tissue without direct visualization of the nerves, was reported to have a more significant effect on urinary function than the nerve-sparing method. 3 Since long-term NB worsens the renal function in the medium to long term, studies have been conducted to determine methods to improve the procedure. 4 One such procedure, a systematic autonomic nerve-sparing RH, has been proposed, wherein only the branch of the uterine nerve is cut from the pelvic plexus, sparing all other autonomic nervous systems.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, posterior layer treatment is performed in type IV RH, but subsequent aggregation and incision of the para‐vaginal tissue would result in a collective incision of the pelvic plexus, causing postoperative neurogenic bladder (NB). In addition, RH, which involves treatment of para‐connective tissue without direct visualization of the nerves, was reported to have a more significant effect on urinary function than the nerve‐sparing method 3 . Since long‐term NB worsens the renal function in the medium to long term, studies have been conducted to determine methods to improve the procedure 4 .…”

Section: Introductionmentioning

confidence: 99%

A simplified procedure of nerve‐sparing radical hysterectomy

Komatsu

Okawa

Hikino

et al. 2022

J of Obstet and Gynaecol

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Aim We devised a simplified nerve‐sparing radical hysterectomy that is simpler than commonly used procedures. Methods We retrospectively examined 16 cases of classical non‐nerve‐sparing radical hysterectomy (non‐nerve‐sparing group) and 16 cases of simplified nerve‐sparing radical hysterectomy (nerve‐sparing group) performed between 2019 and 2020. We examined and compared the duration of surgery, blood loss, perioperative complications, postoperative urinary function (presence or absence of urinary sensation, number of days with residual urine measurement, and frequency and duration of oral sustained release urapidil capsules and self‐catheterization), and short‐term prognosis between the two groups. Results Compared to conventional non‐nerve‐sparing radical hysterectomy, the duration of surgery for nerve‐sparing radical hysterectomy was significantly shorter (407 [339–555] min vs. 212 [180–356] min; p < 0.001), and blood loss was significantly less. Compared to the nerve‐sparing group, the non‐nerve‐sparing group had more cases of oral urapidil use and a higher frequency of clean intermittent catheterization. Clean intermittent catheterization was required in two cases in the nerve‐sparing group; however, it was withdrawn at 180 and 240 days. Conversely, clean intermittent catheterization was still required in three cases in the non‐nerve‐sparing group. There were no statistically significant differences in progression‐free survival and overall survival between the two groups. Conclusion The simple nerve‐sparing radical hysterectomy resulted in shorter duration of surgery and less blood loss as well as in a clear improvement in the postoperative urinary status and short‐term prognosis. This technique simplifies nerve‐sparing radical hysterectomy, which is commonly thought to be complicated, making it easier to understand.

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“…1,4,5,9 Although the trend in use of less invasive procedures, including simple hysterectomy and the aforementioned modified approach for the management of early-stage cervical cancer may be increased, 12 much concern is present whether the "radicality (extent) of surgery" is adequate. 12,13 Dr. Sia used the National Cancer Database to review the case of women with FIGO stage IA2 and IB1 (<2 cm) cervical cancer between 2004 and 2015 and they found although simple hyster4ectomy did not influence the 5-year survival outcome for FIGO stage IA1 cancer (95.1% for RH and 97.6% for simple hysterectomy with HR of 0.70, 95% CI 0.41-1.20), 5-year survival was significantly better in women with FIGO IB1 treated with RH compared to that with simple hysterectomy (95.3% versus 92.4% with HR 1.55, 95% CI 1.18-2.03), suggesting the parametrial resection (parametrectomy) during hysterectomy (RH) is a critical procedure as the treatment of choice for women with FIGO stage IB1 cervical cancer. 12 Moreover, Dr. Zapardiel further identified factor associated with voiding dysfunction after radical parametrectomy (similar to the meaning of RH), and found previous pregnancy and type of parametrectomy are independent factors associated with PFD, although PFD are temporary and the majority of the patients recover in less than 30 days.…”

mentioning

confidence: 99%