title: Self-reported sexual, bowel and bladder function in cervical cancer patients following different treatment modalities: longitudinal prospective cohort study.
abstract: OBJECTIVE
  Conventional radical hysterectomy with pelvic lymphadenectomy (RHL) for early-stage cervical cancer is associated with significant bladder, anorectal, and sexual dysfunction. Nerve-sparing modification of RHL (NS-RHL) has been developed with the aim to reduce surgical treatment-related morbidity. Postoperative radiation therapy (RT) is offered to patients with unfavorable prognostic features to improve local control. The aim of the study was to assess self-reported morbidity of various types of treatment in cervical cancer patients.
  
  
  METHODS
  Self-reported symptoms were prospectively assessed before and 1 and 2 years after treatment by the Dutch Gynaecologic Leiden Questionnaire.
  
  
  RESULTS
  Included were 229 women (123 NS-RHL and 106 conventional RHL). Ninety-four (41%) received RT. Up to 2 years (response rate, 81%), women reported significantly more bowel, bladder, and sexual symptoms compared with the pretreatment situation. No significant difference was found between the conventional RHL and NS-RHL with the exception of the unexpected finding that a smaller percentage in the NS-RHL group (34% vs 68%) complained about numbness of the labia and/ or thigh. Radiation therapy had a negative impact on diarrhea, urine incontinence, lymphedema, and sexual symptoms (especially a narrow/short vagina).
  
  
  CONCLUSIONS
  In the current longitudinal cohort study, treatment for early-stage cervical cancer was associated with worse subjective bladder, anorectal, and sexual functioning, irrespective of the surgical procedure used. Postoperative RT resulted in a significant deterioration of these functions. The results have to be interpreted with caution in view of the study design and method used.
authors.affiliation: Departments of *Gynaecology †Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Quirine D
authors.initials: QD
authors.lastname: Pieterse
authors.forename: Gemma G
authors.initials: GG
authors.lastname: Kenter
authors.forename: Cornelis P
authors.initials: CP
authors.lastname: Maas
authors.forename: Cor D
authors.initials: CD
authors.lastname: de Kroon
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
authors.forename: J Baptist M Z
authors.initials: JB
authors.lastname: Trimbos
authors.forename: Moniek M
authors.initials: MM
authors.lastname: Ter Kuile
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007422:Intestines / Q000502:physiology*; D008137:Longitudinal Studies; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000706:statistics & numerical data; D057566:Self Report; D012725:Sexual Behavior / Q000502:physiology*; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000502:physiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*