Increased incidence of neurogenic bladder after radical hysterectomy for cervical cancer: A nationwide population-based cohort study

Abstract

Background: The effect of radical hysterectomy for patients with cervical cancer on voiding function remains controversial. The purpose of this study was to examine the association between radical hysterectomy for patients with cervical cancer and the odds of developing neurogenic bladder by using data from the National Health Insurance Research Database (NHIRD) in Taiwan. Methods: We identified 17 936 patients who underwent radical hysterectomy for cervical cancer between 2000 and 2013 among inpatients registered in the Longitudinal Health Insurance Database in Taiwan. Of the patients, those diagnosed as having cervical cancer without radical hysterectomy were selected and compared as a matched control group. Patients diagnosed as having cervical cancer before the index date, those with neurogenic bladder dysfunction before tracking, and those aged <20 years were excluded. The hazard ratios (HRs) of neurogenic bladder and other variants of interest were further calculated using a multivariate Cox regression analysis. The cutoff p value of <0.05 was regarded as statistically significant. Results: The adjusted HR (aHR) of subsequent neurogenic bladder was higher in the hysterectomy group (aHR = 1.205; 95% CI, 1.086-1.440; p = 0.029) than in the control group during the follow-up period. As to the age subgroups, the patients aged 20 to 44 years (aHR = 3.321, p = 0.001) had a significantly increased risk of developing neurogenic bladder after radical hysterectomy as compared with those aged 45 to 64 years (aHR = 1.193, p = 0.012). Conclusion: Patients with cervical cancer undergoing radical hysterectomy have an increased risk of neurogenic bladder, which may result from nerve denervation caused by the operation. These patients should be informed of the potential risk of voiding dysfunction during discussion of the subsequent management for cervical cancer.

Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

“…Therefore, the obstetricians sampled in this study may not have been completely reflective of all obstetricians in Taiwan. Furthermore, atosiban is out-of-pocket in Taiwan and not covered by the Taiwan National Health Insurance (NHI), which is the main source of medical care for the general population in Taiwan [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ], and it may have influenced the decision making in clinical practice. The length of the tocolytic used in PPROM was also not included in the survey, so questions regarding the balance of tocolysis and intrauterine infection risk could not be answered.…”

Neurogenic bladder in patients with cervical cancer after treatment

“…Therefore, Dr. Chou also clearly demonstrated its possibility as the limitation in their study. 11 Additionally, as shown by authors, the different approach for RH or extent of radicality is significantly associated with PFD, including neurogenic bladder. 11 One critical and important issue about the QoL and oncology safety of women with cervical cancer after the use of modified approach based on less in place of the conventional exploratory or abdominal RH, such as minimally invasive surgery (laparoscopic and robotic approach) and nerve-sparing RH is still arguable and consensus is not in agreement for all gynecological oncologists.…”

“…In the October issue of the Journal of the Chinese Medical Association, Dr. Chou and colleagues used a Nationwide population-based database (Longitudinal Health Insurance Database [LHID] from the National Health Insurance Research Database [NHIRD]) to assess the risk of neurogenic bladder in women with cervical cancer after RH. 11 The authors analyzed 39,793 women with cervical cancer after treatment, and the authors used an age-and index year-matched strategy to compare the risk of development of neurogenic bladder of women who were treated with and without RH (17,936 in each group). 11 During 372,836 person-year follow-up period, a total of 1087 subjects have been complicated with neurogenic bladder (592 [3.3%] in the RH group and 495 [2.76%] in the non-RH group), contributing to adjusted hazard ratio (aHR) as 1.2 with 95% confidence interval (CI) of 1.1-1.4).…”

“…11 The authors analyzed 39,793 women with cervical cancer after treatment, and the authors used an age-and index year-matched strategy to compare the risk of development of neurogenic bladder of women who were treated with and without RH (17,936 in each group). 11 During 372,836 person-year follow-up period, a total of 1087 subjects have been complicated with neurogenic bladder (592 [3.3%] in the RH group and 495 [2.76%] in the non-RH group), contributing to adjusted hazard ratio (aHR) as 1.2 with 95% confidence interval (CI) of 1.1-1.4). 11 Furthermore, the women in the younger age group (age between 20 and 44 years) had a significantly increased risk of the development of neurogenic bladder after RH compared with those in women aged ≥45 years of age, and of most importance, patients over 65 years of age did not increase any risk of the development of neurogenic bladder.…”

“…11 During 372,836 person-year follow-up period, a total of 1087 subjects have been complicated with neurogenic bladder (592 [3.3%] in the RH group and 495 [2.76%] in the non-RH group), contributing to adjusted hazard ratio (aHR) as 1.2 with 95% confidence interval (CI) of 1.1-1.4). 11 Furthermore, the women in the younger age group (age between 20 and 44 years) had a significantly increased risk of the development of neurogenic bladder after RH compared with those in women aged ≥45 years of age, and of most importance, patients over 65 years of age did not increase any risk of the development of neurogenic bladder. 11 The current study is interesting and worthy of further discussion.…”