Urinary retention between nerve-sparing radical hysterectomy and radical hysterectomy for cervical cancer: A meta-analysis

Abstract

This study intended to assess the urinary retention between nerve-sparing radical hysterectomy and radical hysterectomy in cervical cancer. Relevant studies were selected from databases of PubMed, Embase, Wanfang, and China National Knowledge Internet with the last report up to January 15, 2022. Hazard ratio (HR) and 95% confidence interval (CI) were chosen as the evaluation index. Heterogeneity was assessed using Cochran Q test and I2 test. Subgroup analysis was conducted based on areas and cancer types (primary and metastatic cancer). A total of 8 articles (retrospective cohort studies) were selected in the meta-analysis. There were significant correlations between nerve-sparing radical hysterectomy and radical hysterectomy in related with urinary retention (HR [95% CI] = 1.78 [1.37, 2.31], P < .001) and (HR [95% CI] = 2.49 [1.43, 4.33], P = .001) of cervical cancer patients. Egger test revealed a significant publication bias (P = .014). Sensitivity analysis via omitting 1 study at each time showed that omission of any study made significant difference (P < .05), indicating reliability and good stability for the analysis. Additionally, there were significant heterogeneities in most subgroups.

Prevalence and Risk Factors of Urinary Retention in Patients With Cervical Cancer

“…The sample sizes of the 25 included studies ranged from 56 to 530 cases (total sample, 4678). There were 9 retrospective studies, 15–23 10 cohort studies, 24–33 and 6 case-control studies, 34–39 which were published in China (n = 20), 15–23,26,27,29,30,33–39 Denmark (n = 1), 24 Italy (n = 2), 25,28 France (n = 1), 31 and New Zealand (n = 1) 32 between 2006 and 2021. Table 1 details the characteristics of the included studies.…”

“…The sample sizes of the 25 included studies ranged from 56 to 530 cases (total sample, 4678). There were 9 retrospective studies, [15][16][17][18][19][20][21][22][23] 10 cohort studies, [24][25][26][27][28][29][30][31][32][33] and 6 case-control studies, [34][35][36][37][38][39] which were published in China (n = 20), [15][16][17][18][19][20][21][22][23]26,27,29,30,[33][34][35][36][37][38][39] Denmark (n = 1), 24 Italy (n = 2), 25,28 France (n = 1), 31 and New Zealand (n = 1) 32 between 200...…”

“…Table 1 details the characteristics of the included studies. According to the NOS scores (Table 2), 4 studies 15,16,18,23 were rated as medium quality and 21 studies 17,[19][20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were rated as high quality.…”

Effectiveness of acupuncture on urinary retention after radical hysterectomy for cervical cancer in China: a systematic review and meta-analysis

“…Currently, RH is considered to be the mainstay of treatment for early-stage cervical cancer (33). The scope of surgical resection includes the uterus, fallopian tubes, upper vagina, main ligament and complete clearance of paravaginal and pelvic lymph nodes, and during the resection process, the pelvic autonomic nerves will be destroyed, and some of the nerves that innervate the bladder will be severed, which, together with the perioperative psychosomatic condition, the change of the anatomical position of the pelvic organs, surgical anesthesia and postoperative pain, lead to bladder contraction and sensory dysfunction, as well as voiding disorders and UR (34)(35)(36)(37)(38)(39). Studies have shown that UR caused by mechanical injury to the urethral muscle due to excessive intraoperative stretching, inhibition of the micturition reflex by anesthetic drugs, and postoperative wound pain or postural changes in the position of the body that are afraid of or unaccustomed to urination can be recovered by itself in less than 60 h, so that if the amount of residual urine still does not return to normal in 1 week after the operation, it suggests that there is a presence of damage to the peripheral nerves that innervate the bladder (40).…”

Data_Sheet_1.docx

“…Currently, RH is considered to be the mainstay of treatment for early-stage cervical cancer (33). The scope of surgical resection includes the uterus, fallopian tubes, upper vagina, main ligament and complete clearance of paravaginal and pelvic lymph nodes, and during the resection process, the pelvic autonomic nerves will be destroyed, and some of the nerves that innervate the bladder will be severed, which, together with the perioperative psychosomatic condition, the change of the anatomical position of the pelvic organs, surgical anesthesia and postoperative pain, lead to bladder contraction and sensory dysfunction, as well as voiding disorders and UR (34)(35)(36)(37)(38)(39). Studies have shown that UR caused by mechanical injury to the urethral muscle due to excessive intraoperative stretching, inhibition of the micturition reflex by anesthetic drugs, and postoperative wound pain or postural changes in the position of the body that are afraid of or unaccustomed to urination can be recovered by itself in less than 60 h, so that if the amount of residual urine still does not return to normal in 1 week after the operation, it suggests that there is a presence of damage to the peripheral nerves that innervate the bladder (40).…”