Favorable factors for preserving bladder function after nerve-sparing radical hysterectomy: A protocol-based validation study

Objectives

To investigate favorable factors of nerve-sparing radical hysterectomy (NSRH) for preserving the pelvic autonomic nerves and subsequent bladder function and to compare the safety between NSRH and conventional radical hysterectomy (CRH) for cervical cancer.

Methods

We recruited 87 consecutive patients with IB1-IIA cervical cancer who underwent NSRH, and reviewed the information of 81 patients who received CRH for historical comparisons. One gynaecologic oncologist performed all operations.

Results

IB1 disease was the only favorable factor for unilateral or bilateral preservation (adjusted OR, 0.245; 95% CI, 0.077-0.774), whereas IB1 disease and squamous cell carcinoma (SqCC) were favorable for bilateral preservation (adjusted ORs, 0.336 and 0.116; 95% CIs, 0.162-0.982 and 0.023-0.581). The median duration of postoperative catheterization (DPC) was different among bilateral, unilateral and failed preservation (median 6 vs 18 vs 90 days; P < 0.001). The median DPC was shorter in NSRH patients with stage IB1 disease or SqCC (7 vs 14 days; P < 0.05) despite no difference between NSRH and CRH in those with IB2-IIA disease or non-SqCC. Survival was not different between NSRH and CRH patients.

Conclusions

IB1 disease and SqCC are favorable for preserving the pelvic autonomic nerves and subsequent bladder function without compromising survival outcomes in patients treated with NSRH.

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