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Factors Affecting Spontaneous Voiding Recovery After Radical Hysterectomy
  1. David Cibula, MD, PhD*,
  2. Jiri Sláma, MD, PhD*,
  3. Petra Velechovská, MD*,
  4. Daniela Fischerova, MD, PhD*,
  5. Michal Zikán, MD, PhD*,
  6. Iva Pinkavová, MD* and
  7. Martin Hill, DSc
  1. *Department of Obstetrics and Gynecology, General Teaching Hospital, First Medical School, Charles University; and
  2. Institute of Endocrinology, Prague.
  1. Address correspondence and reprint requests to David Cibula, MD, PhD, Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic. E-mail: david.cibula{at}iol.cz.

Abstract

Background: The impairment of spontaneous voiding is the most prominent type of morbidity in the early postoperative period after radical hysterectomy. The aim of our work was to evaluate the parameters affecting the recovery of spontaneous voiding.

Methods: Enrolled were women in whom radical procedure for early-stage cervical cancer was performed in the period from 2006 to 2008. Satisfactory spontaneous voiding was characterized by the reduction of postvoiding urine residuum to 50 mL or less in the course of a whole day.

Results: Data from 85 patients were evaluated retrospectively (radical hysterectomy 67, radical parametrectomy 6, and radical trachelectomy 12), of which 35 underwent nerve-sparing modification, 19 underwent type C radicality of procedure, and 31 underwent type D radicality of procedure. Radicality of parametrectomy was the most significant parameter influencing the interval to spontaneous voiding recovery (P < 0.05); significant differences were observed between nerve-sparing and type D procedures. Multivariate analysis revealed 3 significant parameters: procedure radicality (P < 0.001), type of procedure (radical hysterectomy vs radical trachelectomy; P < 0.05), and a negative correlation with body mass index (P < 0.05). Long-term spontaneous voiding impairment lasting more than 6 weeks was observed in 7 patients, of whom 5 had undergone type D procedure.

Conclusions: The radicality of parametrial resection is the most prominent factor determining the interval to spontaneous voiding, with significantly poorer outcomes after type D procedure. Interestingly, another significant parameter in our study was the type of parametrectomy, with better outcomes achieved after radical trachelectomy. Delayed voiding recovery was observed in patients with lower body mass index.

  • Cervical cancer
  • Voiding recovery
  • Nerve-sparing radical hysterectomy
  • Morbidity

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Footnotes

  • This study was supported by a grant from the Ministry of Health of the Czech Republic, no. NS 10037-3.

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