Bladder and urethral dysfunction after radical abdominal hysterectomy: Rehabilitative treatment

Abstract

We studied bladder and urethral function prospectively in 64 patients before and after Wertheim's radical hysterectomy. Immediately after surgery, neurogenic bladder dysfunction of various degrees was found in 70% of all patients who presented difficulty of voiding, with high residual urine and/or stress incontinence. All the patients have received an early rehabilitative treatment with kinesitherapy and/or pharmacological therapy after the bladder catheter removal and the urodynamics' results. We have obtained a satisfactory functional recovery of the bladder activity in 91% of the symptomatic patients.

Identifying selection criteria for non‐radical hysterectomy in FIGO stage IB cervical cancer

“…Indeed, 12 months after a radical hysterectomy, a urinary reflex was still absent in 70% of patients, while 18% had reduced bladder compliance on a cystomanometric curve and 9% showed stress incontinence. 22 Notably, a bladder residue (>100 mL) remained in 6% of patients 12 months after surgery, further highlighting severe and prolonged bladder dysfunction following radical hysterectomy.…”

Pelvic nerve plexus trauma at radical and simple hysterectomy: a quantitative study of nerve types in the uterine supporting ligaments

“…Such modifications in surgical management are now the standard of care in breast carcinoma and vulvar carcinoma . [1][2][3][4][5][6][7][8][9] Radical hysterectomy (RH) and bilateral pelvic lymphadenectomy are the accepted treatment for the International Federation of Gynecology and Obstetrics (FIGO) Stage IB-IIAa cervical carcinoma in the developed world, although worldwide radiotherapy is the more common treatment. 10 The efficacy of RH for FIGO Stage IBb tumors has been shown in numerous large series, with 5-year survival rates of approximately 88% for those with lymph node negative disease, and 38 -61% for those with metastatic lymph node involvement.…”

“…For each, a mean value of the PAI was obtained from five random highpower fields from each section. Randomization of fields for analysis was performed using a random number generator to determine in which direction (north, south, east, or west) and by how many highpower fields (1)(2)(3)(4) to move the microscope. The total PAI equates to the total nerve content of the biopsy and comprises nerve trunks and ganglia and free nerve fibers in the surrounding tissue matrix.…”

Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma

“…Surgical resection of the uterine-supporting structures, such as uterosacral ligament (USL) and cardinal ligament (CL), during radical hysterectomy (RH) has been proved to damage the pelvic autonomic nerves crossing the ligaments (1)(2)(3) and is considered to be the main reason for postoperative bladder and rectal dysfunction of varying severity in cervical cancer patients (4)(5)(6)(7) . Several studies until now have described the nature of dysfunctions that follow RH, paying special interest to the intraoperative damage of the pelvic plexus and the inferior hypogastric nerve, during the ligation of CL-USL (8)(9)(10)(11)(12)(13)(14) . The preservation of the pelvic autonomic nervous system is hindered by the fact that the nerves are not distinctly seen in the surgical field because of their tiny structure and the depth and narrowness of the pelvis.…”