A New Technique for Radical Hysterectomy with Emphasis on Preservation of Bladder Function

Abstract

Bladder dysfunction always occurs, to varying degrees, following radical hysterectomy. In Japan, various techniques for preserving the pelvic autonomic nerves in a radical hysterectomy have been used to reduce the severity of bladder dysfunction. The authors describe a newly developed technique for preserving the pelvic autonomic nerves and present the post-operative urodynamic findings in cases in which this technique was used. Preservation techniques can be broadly classified into three types: preservation of the pelvic parasympathetic nerves, preservation of the pelvic sympathetic nerves, and preservation of the nerves to the bladder. In this new technique, as many of the pelvic parasympathetic nerves as possible are preserved when the cardinal ligament is cut. Then, the cardinal ligament is inserted into and pulled through the anterocranially located connective tissue in front of the pelvic plexus, which lies below the ureter. Finally, as many as possible of the vesical branching nerves are preserved when the posterior layer of the vesicouterine ligament is cut. Between July 1996 and February 1999, 23 women were treated for Stage IB1-IIA cervical cancer, and two women were treated for Stage IIB endometrial cancer. The results of urodynamic studies performed ~1 month after surgery were all within normal ranges: mean duration of bladder drainage, 17.1 ± 6.4 days; mean maximal flow rate, 19.5 ± 12.9 ml/sec; mean postvoiding residual urine volume, 30.5 ± 25.8 ml; and mean maximal desire to void, 311.4 ± 124.0 ml. None of the patients required intermittent self-catheterization. It is concluded that this new technique for preservation of the pelvic autonomic nerves is effective in reducing the severity of bladder dysfunction after a radical hysterectomy and would therefore improve the patient's quality of life.