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Quality of Life and Sexual, Bladder, and Intestinal Dysfunctions After Class III Nerve-Sparing and Class II Radical Hysterectomies: A Questionnaire-Based Study
  1. Antonino Ditto, MD*,
  2. Fabio Martinelli, MD*,
  3. Claudia Borreani, PsyD,
  4. Shigeki Kusamura, MD, PhD,
  5. Francesco Hanozet, MD*,
  6. Cinzia Brunelli, ScD,
  7. Gabriela Rossi, MD*,
  8. Eugenio Solima, MD*,
  9. Rosanna Fontanelli, MD*,
  10. Flavia Zanaboni, MD*,
  11. Barbara Grijuela, MD* and
  12. Francesco Raspagliesi, MD*
  1. *Departments of Gynecologic Oncology,
  2. Departments of Surgery, and
  3. Departments of Psychology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
  1. Address correspondence and reprint requests to Antonino Ditto, MD, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy. E-mail: antonino.ditto{at}


Background: To compare quality of life and bladder, intestinal, and sexual dysfunctions in 2 groups of patients undergoing different types of radical hysterectomies (RHs).

Methods: Patients with cervical cancer who underwent RH have been enrolled in a questionnaire-based study. Quality of life (QoL) and bladder, intestinal, and sexual dysfunctions were evaluated with the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx). Patients were grouped according to the type of RH: group 1, class II RH and group 2, class III nerve-sparing RH (NSRH).

Results: Of 157 women included in the study, 127 filled out the questionnaire. Overall, QoL score assessed with the FACT questionnaire did not differ significantly between the 2 groups. The FACT subscales assessing physical, functional, emotional, and social well-being did not differ significantly between the 2 groups, whereas the FACT-Cx subscales assessing disease-related symptoms in group 2 patients showed a significantly worse score (72 vs 66; P = 0.03). Evaluating singularly the 15 items of the Cx subscales assessing disease-related symptoms, we did not find any significant difference between the 2 groups, but only Cx1 ("I am bothered by discharge or bleeding from my vagina") was significantly worse in group 2 patients. At univariate analysis, we found that NSRH and adjuvant radiotherapy (RT) impact negatively on the FACT-Cx subscales regarding pelvic visceral function. However, at multivariate analysis, only adjuvant RT impact negatively.

Conclusions: Patients submitted to class III NSRH did not present worse QoL and pelvic visceral dysfunctions when compared with class II RH. The RT seems to be a factor impacting negatively on bladder and sexual function.

  • Cervical cancer
  • Radical hysterectomy
  • Nerve-sparing technique
  • Quality of life
  • Questionnaire

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  • No fund have been received for this work.