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New method to prevent bladder dysfunction after radical hysterectomy for uterine cervical cancer
Y Kuwabara1, M Suzuki, M Hashimoto
1Department of Obstetrics and Gynecology, Juntendo University, School of Medicine, Tokyo, Japan.
Objective:
The purpose was to improve the surgical procedures to prevent bladder dysfunction after radical hysterectomy.
Methods:
Twelve patients with stage Ib cervical cancer underwent intraoperative electrical stimulation to identify the vesical branches of the pelvic nerves. Autonomic nerve localization in the vesicouterine ligament was examined in 10 patients immunohistochemically. According to the results of the above studies a new method to preserve the vesical branches was developed. Grades of postoperative bladder dysfunction were compared between new (n = 19) and conventional methods (n = 18).
Results:
Electrical stimulation on the outer surface of the posterior sheath of the vesicouterine ligament caused the increase of intravesical pressure. S-100 protein localized also on this area. Postoperative compliance of the detrusor in cases with the new method demonstrated less decrement from preoperative values than in cases with the conventional method. The new method required significantly fewer days to achieve residual urine volumes less than 50 ml after surgery.
Conclusions:
The new method significantly reduces bladder dysfunction after radical hysterectomy.