To examine whether objective bladder function following robot-assisted radical hysterectomy (RRH) for early-stage cervical cancer is correlated with subjective patient-reported outcomes as well as quality of life during the first year after RRH.
Prospective observational study SETTING: Karolinska University Hospital, Sweden PATIENTS: Women with early stage cervical cancer (FIGO stage IA2-IB1) between July 2017 and May 2019 were assessed for eligibility.
Robotic radical hysterectomy (RRH) MEASUREMENTS AND MAIN RESULTS: Subjective bladder function was evaluated with the Female Lower Urinary Tract Symptoms and Urinary Incontinence Quality of Life modules of the International Consultation on Incontinence Questionnaire. Objective urinary function was characterized with urodynamic tests and the nerves ablated at RRH were quantified by using immunohistochemical staining of biopsies from the resected paracervix, vesico-uterine and sacro-uterine ligaments. Twenty-seven women were included for analysis at baseline, two weeks, three months and 12 months after surgery. RRH caused hypotonia of the urinary bladder (p<.05). Patient reported outcomes of voiding and filling dysfunction were most significant 2 weeks after surgery (p<.05) but for most of the women bladder function recovered within 3 months. No correlations were found with either subjective nor objective urinary function and the number of ablated nerves.
For the majority of women, objective and subjective urinary bladder dysfunction recovered within 3 months after RRH. The absence of correlation between functional outcomes and ablated autonomous nerves suggest that other underlying causes play a significant role. Early detection of bladder overextension after RRH is paramount and the role of postoperative bladder catherization needs further investigation.
Journal of minimally invasive gynecology. 2022 May 30 [Epub ahead of print]
Emelie Wallin, Henrik Falconer, Joseph Carlson, Cecilia Haglund, Lotta Renström Koskela, Angelique Flöter Rådestad
Department of Women´s and Children´s Health and Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden. Electronic address: ., Department of Women´s and Children´s Health and Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden., Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden., Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden., Department of Women´s and Children´s Health and Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden and Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.