THE EFFECT OF TENS ON POSTOPERATIVEURINARY FUNCTION IN EARLY CERVICAL CANCER
W. CHENG, S. WANG, X. SUN, J.WANG;
Ob&Gyn, Peking Univ. People's Hosp., Beijing, China.
Introduction: Cervical cancer isthe fourth most common cancer in women worldwide, with an estimated528000 new cases in 2012, 28.8% of which are from China. More women with cervical cancer are detected at early stage now,whose 5 year survival rate can reach 95% with Piver III hysterectomyplus pelvic lymphadenectomy.  Postoperative urinarydysfunction are common, with incidence of 15-100% after radicalhysterectomy, presumably associated to autonomic nerve and muscledamage during surgery. Transcutaneous electrical nervestimulation (TENS) is a promising therapy for urinary dysfunction,reported to be safe and effective in treating non-neurogenicoveractive bladder syndrome. Our previous study has shown that TENShad no significant influence on apoptosis or proliferation of tumorcell. However, it is still unclear whether TENS is truly effective inimproving postoperative urinary function of cervical cancerpatients.
Objective: The aim of this study is toinvestigate whether cervical cancer patients after Piver IIIhysterectomy plus pelvic lymphadenectomy experience less urinarydysfunction after postoperative treatment with TENS.
Methods:This study is a multi-center, prospective, randomized controlledclinical trial. 68 patients with early stage cervical squamous cellcarcinoma underwent Piver III hysterectomy were recruited andrandomized to study group (39 patients) and control group (29patients). Residual urinary volume (RUV), uroflowmetry and UDI-6score were recorded on 14d, 21d, 28d and 3 months after surgery. Inthe study group, TENS started on the 7th day after operation, lasting2 to 3 courses, with 7 days for each course. Patients whose RUV<100ml on 14d received 2 courses of TENS with urinary catheter removedon 14d, while the rest of them complete 3 courses whose urinarycatheter were keeping till RUV<100ml. In the control group,patients were monitored and treated all the same but without usingTENS. We compared the two groups on RUVs(14d), UDI-6 score,uroflowmetry and 1-hour pad test (28d and 3m) . The max current ofTENS was adjusted according to patients’ pain intensity, no morethan 100mA.
Results: 1. There were no significantdifference between urinary retention rate (RUV>100ml) in studygroup (28.2%, 11/39) and control group (20.7%, 6/29) on 14d. 87.2%(34/39) patients in study group removed the catheter successfully on21d which was higher than that in control group (82.8%, 24/29) buthas no significant difference (P>0.05). 2. UDI-6 score isslightly higher in study group compared to control group both at 28dand 3 months postoperatively, but no significant difference(P>0.05).3. Although no significant difference was shown in urine flow rate,there was tendency for higher average flow rate in 21d and shorter Tpeak both on 21d and 3 month in study group(P>0.05). 4.There was no significant difference in 1h hour pad test between twogroups both on 21d and 3 month.
Conclusions: The benefit ofTENS in improvement of urination function in cervical cancer patientsunderwent Piver III hysterectomy was not confirmed by currentresults, which may consequence from limited sample.
References:1. International journal of cancer, 2015, 136(5): E359-E386.2. Gynecol Oncol, 2006, 100 (3):556-560. 3. Crit RevOncolHematol, 2011, 80 (2): 323-329.
Postoperativeproportion of RUV>100ml on 14d and keeping urinary catheter>21d in SG and CG
Proportionof keeping urinary catheter>21d
AveragePFDI-20-UDI-6 score of study group and control group ( 28d and3month postoperatively).
uroflowmetryand 1-hour pad test results of study group and control group (28dand 3month)
Averageflow rate (ml/s)