Huepenbecker Sarah, Santía María Clara, Harrison Ross, Dos Reis Ricardo, Pareja Rene, Iniesta Maria D, Meyer Larissa A, Frumovitz Michael, Zorrilla-Vaca Andres, Ramirez Pedro T
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Obstetrics and Gynecology, Asociacion de Medicos y Profesionales del Hospital Aleman, Buenos Aires, Buenos Aires, Argentina.
Int J Gynecol Cancer. 2022 Aug 1;32(8):986-992. doi: 10.1136/ijgc-2022-003654.
To evaluate whether the timing of postoperative urinary catheter removal is associated with voiding dysfunction after radical hysterectomy for early cervical cancer within contemporary surgical practice.
We performed an institutional retrospective cohort study of patients who underwent Piver type II-III open or minimally invasive radical hysterectomy for early-stage cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1 with lymphovascular invasion to stage IIA) between January 2006 and December 2019. We compared voiding dysfunction (inability to spontaneously void with a post-void residual <100 mL after catheter removal) and outcomes based on postoperative timing of urinary catheter removal using univariate and multivariate logistic regressions.
Among 234 patients, 86 (36.8%) underwent open surgery and 112 (47.9%) used enhanced recovery after surgery (ERAS) pathways. 29 (12.4%) patients had urinary catheter removal between 1-5 days postoperatively (group 1), 141 (60.3%) between 6-10 days (group 2), and 64 (27.3%) between 11-15 days (group 3). The overall rate of voiding dysfunction was 11.5%, with no difference between group 1 (17.2%), group 2 (11.3%), and group 3 (9.4%) (p=0.54). Group 1 had a significantly shorter time from surgery to spontaneous voiding (4 days, IQR 3-5 days) compared with group 2 (8 days, IQR 7-10 days) and group 3 (13 days, IQR 11-15 days) (p<0.01). There was no difference in hospital length of stay, urinary tract infection, or re-admission due to a genitourinary complication within 60 days of surgery based on timing of catheter removal. On multivariate analysis, the odds of voiding dysfunction did not differ by tumor size, type of hysterectomy, cancer stage, surgical approach, ERAS timeframe, or timing of catheter removal group.
There was no difference in voiding dysfunction or postoperative genitourinary complications based on timing of urinary catheter removal after radical hysterectomy. Early catheter removal should be considered in this population.
在当代外科实践中，评估早期宫颈癌根治性子宫切除术后拔除导尿管的时机是否与排尿功能障碍相关。
我们对2006年1月至2019年12月期间接受Piver II - III型开放性或微创根治性子宫切除术治疗早期宫颈癌（国际妇产科联盟（FIGO）2009年IA1期伴脉管浸润至IIA期）的患者进行了一项机构回顾性队列研究。我们使用单因素和多因素逻辑回归，比较了排尿功能障碍（拔除导尿管后不能自主排尿且残余尿量<100 mL）以及基于术后拔除导尿管时机的结局。
在234例患者中，86例（36.8%）接受了开放手术，112例（47.9%）采用了术后加速康复（ERAS）路径。29例（12.4%）患者在术后1 - 5天拔除导尿管（第1组），141例（60.3%）在6 - 10天拔除（第2组），64例（27.3%）在11 - 15天拔除（第3组）。排尿功能障碍的总体发生率为11.5%，第1组（17.2%）、第2组（11.3%）和第3组（9.4%）之间无差异（p = 0.54）。与第2组（8天，四分位间距7 - 10天）和第3组（13天，四分位间距11 - 15天）相比，第1组从手术到自主排尿的时间明显更短（4天，四分位间距3 - 5天）（p<0.01）。基于导尿管拔除时机，手术住院时间、尿路感染或术后60天内因泌尿生殖系统并发症再次入院情况无差异。多因素分析显示，排尿功能障碍的几率在肿瘤大小、子宫切除术类型、癌症分期、手术方式、ERAS时间框架或导尿管拔除组时机方面无差异。
根治性子宫切除术后，基于导尿管拔除时机，排尿功能障碍或术后泌尿生殖系统并发症无差异。该人群应考虑早期拔除导尿管。
