title: Nerve-sparing class III-IV radical hysterectomy: urodynamic study and surgical technique.
abstract: OBJECTIVE
  The aim of this study was to demonstrate the impact of the nerve-sparing radical hysterectomy on the bladder function.
  
  
  METHODS
  Patients with cervical cancer stage 1B1 to IIB, who underwent type 3 to 4 nerve-sparing radical hysterectomy, were evaluated with urodynamic test before and within 6 months from surgery. Stage IB2 to IIB patients were treated with platinum-based neoadjuvant chemotherapy. Bladder catheter was removed in postoperative day 4, and patients were educated to clean intermittent self-catheterization. Urinary symptoms were evaluated with a questionnaire administered before and 3, 6, and 12 months after surgery. Patients treated with adjuvant chemoradiotherapy were excluded from the study.
  
  
  RESULTS
  Fifteen patients (stage IB1, 7; IB2, 3; and IIB, 5) completed the study. Eight (53%) patients were treated with neoadjuvant chemotherapy. Bilateral nerve sparing was feasible in 13 (87%) patients, unilateral in 2 (13%). At postoperative day 10, only 3 (20%) patients continued intermittent self-catheterization. Before surgery, 1 (6.2%) patient had urodynamic symptoms of incontinence, and 3 (20%) had overactive bladder detrusor. Postoperative urodynamic study (median, 4 months; range, 3-6) showed reduced detrusor activity in 8 (53%), overactive detrusor in 4 (27%), and normal profile in 3 (20%) patients. Reduced bladder sensation was observed in 2 (12.5%), and residual urine more than 30% of bladder capacity in 2 (12.5%) patients, respectively. No patient showed de novo incontinence. Bladder compliance was unchanged.
  
  
  CONCLUSIONS
  The separation of the hypogastric nerve from the parametrium is a feasible surgical step, which can be implemented in the radical hysterectomy technique in different clinical settings. The comparative urodynamic study showed a mild functional impairment in the early postoperative period. The most frequent finding was the reduced detrusor activity observed during the voiding phase, consistent with the straining needed to void reported in the questionnaire. These data suggest that a mild bladder impairment occurs despite the conservation of the hypogastric nerve.
authors.affiliation: Department of Gynecology and Obstetrics, S. Maria Goretti Hospital, Latina, Italy. francesco.maneschi@tin.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Maneschi
authors.forename: Palmiero
authors.initials: P
authors.lastname: Ianiri
authors.forename: Michele
authors.initials: M
authors.lastname: Sarno
authors.forename: Francesco
authors.initials: F
authors.lastname: Gagliardi
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011182:Postoperative Care; D011300:Preoperative Care; D013153:Splanchnic Nerves / Q000293:injuries / Q000502:physiology*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation* / Q000502:physiology*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control; D014563:Urodynamics; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*