Objectives We evaluated the pelvic autonomic nerve function and quality of life after type C1 hysterectomy using intraoperative nerve monitoring (INM) for early-stage cervical cancer.
Methods From 2015 to 2016, 11 patients with stage IB cervical cancer were enrolled prospectively to receive type C1 hysterectomy using INM (NCT02952183). After confirming that the hypogastric, pelvic splanchnic, and vesical branches of the pelvic plexus, we evaluated their function by measuring the bladder, vagina, and rectum pressure electrical stimulation of the pelvic autonomic nerves. Moreover, we investigated the quality of life related to the pelvic organ function before and three months after surgery.
Results Bilateral pelvic autonomic nerves were preserved in all patients. When we stimulated parasympathetic nerves, we found that periodic and regular contraction of the bladder and rectum. In contrast, the stimulation of sympathetic nerves decreased the interval to contraction and the duration of contraction and increased the maximal pressure and frequency of contraction despite no consistent change of the vaginal pressure. Moreover, despite the normal residual urine volume, the sustained voiding difficulty, abdominal distension, discomfort, and fecal incontinence increased after surgery, whereas there was no consistent change in the sexual function.
Conclusions The pelvic sympathetic and parasympathetic nerves may show the opposite effect on each other for the bladder and rectal function. Furthermore, the quality of life related to the bladder and rectum may decrease despite the pelvic autonomic nerve preservation using INM during type C1 hysterectomy for stage IB cervical cancer.
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