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Blogger's Note: also see blog post of Jan 25th, 2013; this is ongoing research from Japan
Bladder function after modified posterior exenteration for primary gynecological cancer
WIKI: Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. The urinary bladder, urethra, rectum, and anus are removed.
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AbstractObjective
Bladder
dysfunction caused by autonomic nerve injury is a well-recognized
complication of pelvic surgery. Modified posterior exenteration with or
without nerve preservation was performed in patients with primary
ovarian, tubal, peritoneal, and endometrial cancer. The aim of this
retrospective study was to evaluate the impact of this surgical
technique on bladder function.
Methods
Among
the 60 consecutive patients in whom modified posterior exenteration was
performed, bilateral and unilateral nerve-sparing surgeries were
performed in 43 (72%) and 15 (25%) patients, respectively. In the
remaining 2 patients (3%), the pelvic autonomic nerves on both sides
were sacrificed. Symptoms and bladder function after bilateral or
unilateral nerve-sparing surgery were analyzed using standardized
questionnaires before and 3 and 6 months after surgery.
Results
All
patients with bilateral nerve-sparing surgery had sufficient
micturition from the early postoperative period. Though 40% of the
patients with unilateral nerve-sparing surgery had difficulty in
spontaneous voiding and needed intermittent catheterization, voiding
ability of them improved and no self-catheterization was required
3 months after surgery. The assessment of patient questionnaires
suggested that bladder function was acceptable in both groups at
6 months. Patients with bilateral nerve-sacrificing surgery complained
of neurogenic bladder requiring self-catheterization even 6 months after
surgery.
Conclusions
This
preliminary study showed that preservation of bladder function after
modified posterior exenteration was feasible with a nerve sparing
approach and that standardized outcome measures could be used to monitor
this. However, careful follow-up is required. Future larger studies are
needed to investigate pelvic autonomic nerve function.
Highlights
►
We evaluate the bladder function after modified posterior exenteration
as part of cytoreductive surgery for gynecological cancer.
► Symptoms and bladder function were assessed before and 3 and 6 months after surgery using the validated questionnaires.
► Preservation of bladder function after modified posterior exenteration is possible even with unilateral nerve-sparing dissection.
► Symptoms and bladder function were assessed before and 3 and 6 months after surgery using the validated questionnaires.
► Preservation of bladder function after modified posterior exenteration is possible even with unilateral nerve-sparing dissection.
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