INVESTIGATION ON PELVIC FLOORFUNCTION IN PATIENTS WITH CERVICAL CANCER POST RADICAL HYSTERECTOMY
Dept. of Obstetricsand Gynecology, Peking Univ. People's Hosp., Beijing, China.
Introduction: Class III radicalhysterectomy (RH III)_plus pelvic lymphadenectomy is the standardsurgery for early stage cervical cancer (CC) patients, the 5 yearsurvival rate is about 90%, but pelvic floor disorders especiallybladder dysfunction are common due to damaged vessels and nervefibers following surgery which decreased the life quality of thesepatient. Unfortunately there was few study focus on the pelvic floorfunction after RH III and no effective treatment for this disorders.Modern comprehensive treatment requires not only tumor resection butincreasing the quality of life of postoperation.
Objective:Investigate the life quality and pelvic floor function of cervicalcancer patients with type III hysterectomy, to provide theoreticalbasis for improving the quality of life of these patients.
Methods:381 cervical neoplasm patients who treated with type III hysterectomyin 14 research centers from February 2012 to June 2016 wereinvestigated and evaluated for postoperative pelvic floor functionwith PFIQ and PFDI-20 questionaires in 6 months and 12 months aftersurgery. 279 patients among them were examined with U8 or 8-plusphenix neuromuscular stimulator manufactured by VIVALTIS company inFranch from 3 to 24 months after surgery.
Results: ①ThePFIQ-7 and PFDI-20 scores indicated that postoperative scores weresignificantly increased than preoperative scores (P<0.05),postoperation for 12 months scores were significantly increased thanscores of postoperation for 6 months (P<0.05)(Table 1).Itindicated that decreased life quality of patients after surgry,particular in postoperative 12 moths.②The average time of catheterremoval after surgery was (2.36 ±+ 1.19) weeks. The most commonsymptom of patients from 3 to 24 months after surgery,was urinaryincontinence(25.72%).③The 279 patients accepted examination ofpelvic floor muscle strength and pelvic tension in 3-24 months afteroperation, 53.62%-91.30% patients were significantly lower than thenormal value(Table 2).It indicated the microscopic verification ofpelvic floor function after surgry.
Conclusions: lifequality and pelvic function of cervical cancer patients with type IIIhysterectomy were seriously affecting. Causes include a vegetativedenervation, anatomical changes causing loss of the support of theurethra and the vesical neck as well as the local trauma. Theseverity of vesico-ureteral dysfunction is associated with the degreeof radical hysterectomy. Therapy to ameliorate pelvicfloor function after type III hysterectomy is urgent needed in modernmedicine, that is objective of our subject study inresearch.
References:  If diagnosed at a localizedstage, the 5-year survival rate exceeds 90%. A systematic searchof the medical literature and PubMed from 1950 to 2013 showed thaturinary complications are mainly a decreased sensation of need, urineoutput and bladder compliance, an increase in residual urine volume,and a urinary incontinence. Causes include a vegetative denervation,anatomical changes causing loss of the support of the urethra and thevesical neck as well as the local trauma.
Table1. 381 patients PFIQ-7 and PFDI-20 scores(x ± s )
6months after operation
12months after operation
Z(comparedbefore and 6 months after operation)
P(comparedbefore and 6 months after operation)
Z(comparedbefore and 12 months after operation)
P(comparedbefore and 12 months after operation)
Z(compared6 months and 12 months after operation)
P(compared6 months and 12 months after operation)
Table2 pelvic floor electromyography
mean±standard(x± s )or median (range)
pelvicfloor muscle potential(uv)
musclestrength of type I (grade)
Imuscle fiber fatigue(%)
musclestrength of type II (grade)
IImuscle fiber fatigue(%)
musclecontraction at 5°(g/cm2)
musclecontraction at 10°(g/cm2)