[Function evaluation of urinary, bowel, pelvic floor functions of patients after nerve-sparing radical hysterectomy...

Objective: To investigate urinary, bowel, pelvic floor functions in patients underwent nerve-sparing radical hysterectomy(NSRH) based on CC-PRO137(cervical cancer-patient reported outcome 137 scale,CC-PRO137)scale. Methods: In this retrospective study, we retrospectively enrolled 304 patients with primary cervical cancer who underwent type-C1 radical hysterectomy in the Obstetrics and Gynecology Hospital, Fudan University from Oct, 2018 to Jun, 2021. The CC-PRO137 scale was used to evaluate urinary, bowel, pelvic floor functions at two time points: within 6 months and more than 1 year after surgery. Scores for urinary, bowel, and pelvic-floor functions were compared between the two postoperative intervals. Results: The average age of 304 patients was (47.1±10.6) years.Postoperative urinary, bowel, and pelvic floor functions scores within 6 months were (4.24±0.70), (4.41±0.42), and (4.67±0.46), respectively, while scores at 1 year or more postoperatively were (4.32±0.66), (4.44±0.38), and (4.69±0.45); within 6 months postoperatively, patients aged≤45 years exhibited higher urinary, bowel, and pelvic floor functions scores [(4.32±0.63) vs (4.15±0.77), (4.48±0.34) vs (4.35±0.47), (4.77±0.35) vs (4.59±0.52)] compared to patients aged >45 years (P<0.05); at 1 year or more postoperatively, patients aged ≤45 years demonstrated higher urinary and pelvic floor functions scores [(4.42±0.56) vs (4.22±0.74), (4.75±0.37) vs (4.64±0.49)] than patients aged >45 years (P<0.05), while no statistically significant difference existed in bowel function scores between groups (P>0.05); within 6 months postoperatively, statistically significant differences were observed in urinary, bowel, and pelvic floor functions scores among FIGO(International Federation of Gynecology and Obstetrics) stage Ⅰ, Ⅱ, and Ⅲ patients (all P<0.05), whereas at 1 year or more, FIGO stage Ⅱ and Ⅲ patients showed lower urinary function scores compared to stage Ⅰ patients (both P<0.05), FIGO stage II patients had lower pelvic floor function scores (P=0.001), but no significant differences existed in bowel function scores across stages (P>0.05); both within 6 months and at 1 year or more postoperatively, statistically significant differences in urinary function scores were found between patients receiving no adjuvant therapy or postoperative chemotherapy only versus those receiving postoperative concurrent chemoradiotherapy (P<0.001); at 1 year or more, significant differences in bowel function scores existed between no adjuvant therapy versus concurrent chemoradiotherapy (P=0.030) and borderline significance between chemotherapy only versus concurrent chemoradiotherapy (P=0.070), while pairwise comparisons of pelvic floor function scores showed no statistical significance (P<0.05). Conclusions: Nerve-sparing radical hysterectomy for cervical cancer can markedly reduce the complications caused by intraoperative injury to the pelvic autonomic nerves; nevertheless, some patients may still develop urinary frequency, urgency, voiding or defecation difficulties, and pelvic organ prolapse after surgery. Patients older than 45 years, with advanced FIGO stage, or who require postoperative concurrent chemoradiation should undergo regular follow-up to assess urinary, bowel, and pelvic floor functions after surgery.