Gynaecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain.
Gynaecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, CEEGOG, Prague, Czech Republic.
Gynecol Oncol. 2021 Mar;160(3):729-734. doi: 10.1016/j.ygyno.2020.12.018. Epub 2021 Jan 6.
Voiding dysfunctions represent a leading morbidity after radical hysterectomy performed in patients with early-stage cervical cancer. The aim of this study was to perform ad hoc analysis of factors influencing voiding recovery in SENTIX (SENTinel lymph node biopsy in cervIX cancer) trial.
The SENTIX trial (47 sites, 18 countries) is a prospective study on sentinel lymph node biopsy without pelvic lymphadenectomy in patients with early-stage cervical cancer. Overall, the data of 300 patients were analysed. Voiding recovery was defined as the number of days from surgery to bladder catheter/epicystostomy removal or to post-voiding urine residuum ≤50 mL.
The median voiding recovery time was three days (5th-95th percentile: 0-21): 235 (78.3%) patients recovered in <7 days and 293 (97.7%) in <30 days. Only seven (2.3%) patients recovered after >30 days. In the multivariate analysis, only previous pregnancy (p = 0.033) and type of parametrectomy (p < 0.001) significantly influenced voiding recovery >7 days post-surgery. Type-B parametrectomy was associated with a higher risk of delayed voiding recovery than type-C1 (OR = 4.69; p = 0.023 vs. OR = 3.62; p = 0.052, respectively), followed by type-C2 (OR = 5.84; p = 0.011). Both previous pregnancy and type C2 parametrectomy independently prolonged time to voiding recovery by two days.
Time to voiding recovery is significantly related to previous pregnancy and type of parametrectomy but it is not influenced by surgical approach (open vs minimally invasive), age, or BMI. Type B parametrectomy, without direct visualisation of nerves, was associated with longer recovery than nerve-sparing type C1. Importantly, voiding dysfunctions after radical surgery are temporary, and the majority of the patients recover in less than 30 days, including patients after C2 parametrectomy.
排尿功能障碍是早期宫颈癌根治性子宫切除术后的主要发病率之一。本研究旨在对 SENTIX（宫颈癌前哨淋巴结活检）试验中影响排尿恢复的因素进行专门分析。
SENTIX 试验（47 个站点，18 个国家）是一项关于早期宫颈癌前哨淋巴结活检而不进行盆腔淋巴结清扫的前瞻性研究。总共分析了 300 例患者的数据。排尿恢复定义为从手术到膀胱导管/耻骨上造口术去除或残余尿 <50ml 的天数。
中位排尿恢复时间为 3 天（5 至 95 百分位数：0-21）：235 例（78.3%）患者在 <7 天内恢复，293 例（97.7%）在 <30 天内恢复。只有 7 例（2.3%）患者在 >30 天后恢复。在多变量分析中，只有既往妊娠（p=0.033）和参数切除术类型（p<0.001）显著影响术后 >7 天的排尿恢复。与 C1 型相比，B 型参数切除术与排尿恢复延迟的风险更高（OR=4.69；p=0.023 与 OR=3.62；p=0.052），其次是 C2 型（OR=5.84；p=0.011）。既往妊娠和 C2 型参数切除术均可使排尿恢复时间延长两天。
排尿恢复时间与既往妊娠和参数切除术类型显著相关，但与手术方式（开放与微创）、年龄或 BMI 无关。不直接观察神经的 B 型参数切除术与神经保留的 C1 型相比，恢复时间更长。重要的是，根治性手术后的排尿功能障碍是暂时的，大多数患者在 30 天内恢复，包括 C2 参数切除术的患者。
