Sexual, bladder, bowel and ovarian function 1 year after robot-assisted radical hysterectomy for early-stage cervical cancer

Surgery by open radical hysterectomy for cervical cancer is associated with sexual dysfunction as well as lymphedema and bladder problems. Our aim was to assess the impact of robot-assisted laparoscopic radical hysterectomy (RRH) with pelvic lymphadenectomy for early-stage cervical cancer on sexual, bowel, bladder, and lymphatic function and to measure ovarian function after RRH.

Twenty-six women with early-stage cervical cancer during 2011-2013 were investigated before and 1 year after RRH using a validated questionnaire measuring psychological well-being and sexual, bowel, bladder, and lymphatic function. Blood samples for follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex-hormone-binding globulin (SHBG), estradiol, total testosterone, androstenedione, and anti-Müllerian hormone (AMH) were analyzed at baseline and 1 year after treatment.

Anxiety and depression increased in 17/26 (62%) and 16/26 (65%) of the women respectively. Sexual distress symptoms reported 1 year after RRH were numbness of the labia (P = 0.04) and deep pain during intercourse (P = 0.02). Twelve of 26 (46%) had lymphedema, and 10/26 (35%) had bladder problems 1 year after surgery. Levels of FSH and LH were significantly increased (P < 0.01) and AMH decreased (P = 0.02) 1 year after RRH in women <45 years with preserved ovaries. Androgen levels were unchanged.

In our study, RRH was associated with minor sexual dysfunction. RRH may facilitate the preservation of posterior branches from the hypogastric nerve that are important for arousal and orgasm. Bladder problems and lymphedema remain the most frequently reported sequelae. Women with preserved ovaries after RRH may have an early onset of menopause.