NERVE SPARING« RADICAL HYSTERECTOMY – PREVENTION OF POST-OPERATIVE URINARY TRACT DYSFUNCTION

Abstract

Background. Radical hysterectomy is performed on woman with cervical cancer or endometrial cancer that has spread to the cervix. Aims. To find whether our modified radical hysterectomy represents nerve sparing. Methods. In 28 patients, modified radical hysterectomy was applied (study group) and the width of the parametria and vaginal cuff were measured. Using a point-counting technique, nerve areal density was determined in cross sections of resected parametria at 0.5 cm (A), 1 cm (B), and 1.5 cm (C) from the cervix. The results were compared with 26 control patients who underwent classic radical hysterectomy. In the study group urodynamic measurements were performed after operation, and correlations with histologic data were calculated. The survival rates and adjuvant treatment were compared between the groups. Results. Adjuvant treatment was given to 53.57 % in the study and 65.38 % of patients in the control group (P > 0.3). The survival rate after 3 years was 92.85 % in the study and 84.61 % in the control group after more than 5 years. The width of the resected parametria was smaller in the study (mean: right 15.50 mm, left 15.71 mm) compared with the control group (mean: right 22.69 mm; P < 0.013; left 22.96 mm; P < 0.011). The nerve areal density in the lateral part of the right parametrium (C right 6.2 %) was lower in the study than in the control group (C right 9.7 %; P < 0.01). There were several correlations between parametrial width, nerve areal density and urodynamic parameters. Conclusions. Modified radical hysterectomy is less radical, and apparently also nerve sparing. It does not influence survival rates and does not impair the urinary tract function