A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function

TLDR

The study aims to describe a systematic nerve‑sparing radical hysterectomy technique that preserves autonomic bladder nerves and to evaluate its impact on postsurgical bladder function, with a future prospective randomized trial planned. The authors performed the technique on 27 consecutive cervical cancer patients (FIGO stages Ib1–IIb) by systematically preserving the hypogastric, pelvic splanchnic, and pelvic plexus nerves during radical hysterectomy. The procedure succeeded in 22 of 27 patients, and at one year bladder symptoms improved markedly compared to non‑nerve‑sparing cases, with no incontinence among the 22 and only two with abnormal sensation, while overall survival remained unchanged, suggesting the technique preserves bladder function and may enhance quality of life.

Abstract

The objective of this study is to describe a technique for preserving the autonomic nerve systematically, including the hypogastric nerves, pelvic splanchnic nerves, and pelvic plexus and its vesical branches, based on anatomic considerations for the autonomic nerves innervating the urinary bladder, in radical hysterectomies and to assess postsurgical bladder function. A nerve-sparing radical hysterectomy was carried out on 27 consecutive patients with uterine cervical cancer treated between 2000 and 2002. The FIGO stages of the disease consisted of 10 stage Ib1, 6 stage Ib2, 3 stage IIa, and 8 stage IIb. The nerve-sparing procedure was successfully completed in 22 of the 27 patients (81.5%) in the study. At 1 year after the operation, bladder symptoms were significantly improved in the nerve-sparing group compared to the non–nerve-sparing group. Urinary incontinence and abnormal (diminished) bladder sensation were observed in three of the five patients (two patients had both symptoms), for whom the nerve-sparing procedure could not be performed, but none of the 22 patients for whom the nerve-sparing procedure was performed had incontinence, and only two patients had abnormal (increased) bladder sensation ( P = 0.0034 for incontinence and P = 0.030 for abnormal bladder sensation). The patients' survival was not adversely affected by the nerve-sparing procedure. Although it is still preliminary, the surgical technique described in this report is thought to be effective for preserving bladder function, and thus, the quality of life could be improved for patients with cervical cancer who are treated with a radical hysterectomy. For further evaluation of the efficacy of nerve-sparing radical hysterectomy, a prospective randomized trial needs to be performed.