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Hill AJ, Balgobin S, Mishra K, Jeppson PC, Wheeler T, Mazloomdoost D, Anand M, Ninivaggio C, Hamner J, Bochenska K, Mama ST, Balk EM, Corton MM, Delancey J. Recommended standardized anatomic terminology of the posterior female pelvis and vulva based on a structured medical literature review. Am J Obstet Gynecol 2021; 225:169.e1-169.e16. [PMID: 33705749 DOI: 10.1016/j.ajog.2021.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/01/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anatomic terminology in both written and verbal forms has been shown to be inaccurate and imprecise. OBJECTIVE Here, we aimed to (1) review published anatomic terminology as it relates to the posterior female pelvis, posterior vagina, and vulva; (2) compare these terms to "Terminologia Anatomica," the internationally standardized terminology; and (3) compile standardized anatomic terms for improved communication and understanding. STUDY DESIGN From inception of the study to April 6, 2018, MEDLINE database was used to search for 40 terms relevant to the posterior female pelvis and vulvar anatomy. Furthermore, 11 investigators reviewed identified abstracts and selected those reporting on posterior female pelvic and vulvar anatomy for full-text review. In addition, 11 textbook chapters were included in the study. Definitions of all pertinent anatomic terms were extracted for review. RESULTS Overall, 486 anatomic terms were identified describing the vulva and posterior female pelvic anatomy, including the posterior vagina. "Terminologia Anatomica" has previously accepted 186 of these terms. Based on this literature review, we proposed the adoption of 11 new standardized anatomic terms, including 6 regional terms (anal sphincter complex, anorectum, genital-crural fold, interlabial sulcus, posterior vaginal compartment, and sacrospinous-coccygeus complex), 4 structural terms (greater vestibular duct, anal cushions, nerve to the levator ani, and labial fat pad), and 1 anatomic space (deep postanal space). In addition, the currently accepted term rectovaginal fascia or septum was identified as controversial and requires further research and definition before continued acceptance or rejection in medical communication. CONCLUSION This study highlighted the variability in the anatomic nomenclature used in describing the posterior female pelvis and vulva. Therefore, we recommended the use of standardized terminology to improve communication and education across medical and anatomic disciplines.
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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De Paepe KN, Higgins DM, Ball I, Morgan VA, Barton DP, deSouza NM. Visualizing the autonomic and somatic innervation of the female pelvis with 3D MR neurography: a feasibility study. Acta Radiol 2020; 61:1668-1676. [PMID: 32212832 PMCID: PMC7720358 DOI: 10.1177/0284185120909337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of female pelvic malignancies often causes pelvic nerve damage. Magnetic resonance (MR) neurography mapping the female pelvic innervation could aid in treatment planning. PURPOSE To depict female autonomic and somatic pelvic innervation using a modified 3D NerveVIEW sequence. MATERIAL AND METHODS Prospective study in 20 female volunteers (n = 6 normal, n = 14 cervical pathology) who underwent a modified 3D short TI inversion recovery (STIR) turbo spin-echo (TSE) scan with a motion-sensitive driven equilibrium (MSDE) preparation radiofrequency pulse and flow compensation. Modifications included offset independent trapezoid (OIT) pulses for inversion and MSDE refocusing. Maximum intensity projections (MIP) were evaluated by two observers (Observer 1, Observer 2); image quality was scored as 2 = high, 1 = medium, or 0 = low with the sciatic nerve serving as a reference. Conspicuity of autonomic superior (SHP) and bilateral inferior hypogastric plexuses (IHP), hypogastric nerves, and somatic pelvic nerves (sciatic, pudendal) was scored as 2 = well-defined, 1 = poorly defined, or 0 = not seen, and inter-observer agreement was determined. RESULTS Images were of medium to high quality according to both observers agreeing in 15/20 (75%) of individuals. SHP and bilateral hypogastric nerves were seen in 30/60 (50%) of cases by both observers. Bilateral IHP was seen in 85% (34/40) by Observer 1 and in 75% (30/40) by Observer 2. Sciatic nerves were well identified in all cases, while pudendal nerves were seen bilaterally by Observer 1 in 65% (26/40) and by Observer 2 in 72.5% (29/40). Agreement between observers for scoring nerve conspicuity was in the range of 60%-100%. CONCLUSION Modified 3D NerveVIEW renders high-quality images of the female autonomic and pudendal nerves.
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Affiliation(s)
- Katja N De Paepe
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
| | | | | | - Veronica A Morgan
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
| | - Desmond P Barton
- The Royal Marsden NHS Foundation Trust, Department of Gynecological Oncology, London, UK
| | - Nandita M deSouza
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
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Plotti F, Ficarola F, Messina G, Terranova C, Montera R, Guzzo F, DE Cicco Nardone C, Rossini G, Schirò T, Gatti A, Luvero D, Feole L, Angioli R. Tailoring parametrectomy for early cervical cancer (Stage IA-IIA FIGO): a review on surgical, oncologic outcome and sexual function. Minerva Obstet Gynecol 2020; 73:149-159. [PMID: 33249819 DOI: 10.23736/s2724-606x.20.04683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical cancer is currently one of the most common cancers afflicting the female population worldwide and in industrialized countries the presence of screening and a specific diagnostic and therapeutic process has favored early diagnosis of cervical cancer. In literature have found that reducing the radicality on the parametria in early cervical cancer (ECC), reduces complications without impacting oncological outcomes, but the data in the literature are not yet clear. EVIDENCE ACQUISITION Searching on PubMed, we included 1473 articles from January 1974 to 2020. We identified all the studies that compared different type of radical hysterectomy in the primary surgical treatment of ECC. 16 articles were elected for the review. EVIDENCE SYNTHESIS Modified radical hysterectomy (Piver II/Querleu-Morrow Type B) in ECC, if compared to CRH (Piver III/Querleu-Morrow Type C2), is not associated with worse cancer outcome and patient survival, but it is associated with a minor operating time, lower blood loss and minor bladder dysfunction. Nerve sparing radical hysterectomy approach (NSRH/Querleu-Morrow Type C1) compared to CRH (Piver III/Type C2) in the ECC, with our data we can confirm a non-inferiority regarding the oncological outcome. CONCLUSIONS Reduced radicality on the parametrium offers positive effects on the quality of life (sexual life and bladder function) of patients without impacting on survival, oncological outcome.
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Affiliation(s)
- Francesco Plotti
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Fernando Ficarola
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy -
| | - Giuseppe Messina
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Corrado Terranova
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Roberto Montera
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Federica Guzzo
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | | | - Gianmarco Rossini
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Teresa Schirò
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Gatti
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Daniela Luvero
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Laura Feole
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Roberto Angioli
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
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Standardized terminology of apical structures in the female pelvis based on a structured medical literature review. Am J Obstet Gynecol 2020; 222:204-218. [PMID: 31805273 DOI: 10.1016/j.ajog.2019.11.1262] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 12/13/2022]
Abstract
The objectives of this study were to review the published literature and selected textbooks, to compare existing usage to that in Terminologia Anatomica, and to compile standardized anatomic nomenclature for the apical structures of the female pelvis. MEDLINE was searched from inception until May 30, 2017, based on 33 search terms generated by group consensus. Resulting abstracts were screened by 11 reviewers to identify pertinent studies reporting on apical female pelvic anatomy. Following additional focused screening for rarer terms and selective representative random sampling of the literature for common terms, accepted full-text manuscripts and relevant textbook chapters were extracted for anatomic terms related to apical structures. From an initial total of 55,448 abstracts, 193 eligible studies were identified for extraction, to which 14 chapters from 9 textbooks were added. In all, 293 separate structural terms were identified, of which 184 had Terminologia Anatomica-accepted terms. Inclusion of several widely used regional terms (vaginal apex, adnexa, cervico-vaginal junction, uretero-vesical junction, and apical segment), structural terms (vesicouterine ligament, paracolpium, mesoteres, mesoureter, ovarian venous plexus, and artery to the round ligament) and spaces (vesicocervical, vesicovaginal, presacral, and pararectal) not included in Terminologia Anatomica is proposed. Furthermore, 2 controversial terms (lower uterine segment and supravaginal septum) were identified that require additional research to support or refute continued use in medical communication. This study confirms and identifies inconsistencies and gaps in the nomenclature of apical structures of the female pelvis. Standardized terminology should be used when describing apical female pelvic structures to facilitate communication and to promote consistency among multiple academic, clinical, and surgical disciplines.
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Li P, Duan H, Wang J, Gong S, Su G, Li J, Tang L, Zhang Y, Fan H, Liu P, Chen C. Neurovascular and lymphatic vessels distribution in uterine ligaments based on a 3D reconstruction of histological study: to determine the optimal plane for nerve-sparing radical hysterectomy. Arch Gynecol Obstet 2019; 299:1459-1465. [PMID: 30874947 DOI: 10.1007/s00404-019-05108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To present the distribution of neurovascular and lymphatic vessels in uterine ligaments using 3D models based on the pathological staining of serial 2D sections of postoperative specimens. METHODS Serial transverse sections of fresh uterine ligaments from a patient with stage IB1 cervical squamous cell carcinoma were studied using the computer-assisted anatomic dissection (CAAD) technique. The sections were stained with hematoxylin and eosin, Weigert elastic fibers, D2-40 and immunostainings (sheep anti-tyrosine hydroxylase and rabbit anti-vasoactive intestinal peptide). The sections were then digitalized, registered and reconstructed three-dimensionally. Then, the 3D models were analyzed and measured. RESULTS The 3D models of the neurovascular and lymphatic vessels in uterine ligaments were created, depicting their precise location and distribution. The vessels were primarily located in the upper part of the ligaments model, while the pelvic autonomic nerves were primarily in the lower part; the lymphatic vessels were scattered in the uterine ligaments, without obvious regularity. CONCLUSION CAAD is an effective anatomical method to study the precise distribution of neurovascular and lymphatic vessels in uterine ligaments. It can present detailed anatomical information about female pelvic autonomic innervation and the spatial relationship between nerves and vessels and may provide a better understanding of nerve-sparing radical hysterectomy.
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Affiliation(s)
- Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Hui Duan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Jun Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Shipeng Gong
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Guidong Su
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, China
| | - Lei Tang
- Department of Anatomy, Guangdong Province Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou, China
| | - Yan Zhang
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huijian Fan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China.
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China.
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Kietpeerakool C, Aue‐aungkul A, Galaal K, Ngamjarus C, Lumbiganon P. Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). Cochrane Database Syst Rev 2019; 2:CD012828. [PMID: 30746689 PMCID: PMC6370917 DOI: 10.1002/14651858.cd012828.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radical hysterectomy is one of the standard treatments for stage Ia2 to IIa cervical cancer. Bladder dysfunction caused by disruption of the pelvic autonomic nerves is a common complication following standard radical hysterectomy and can affect quality of life significantly. Nerve-sparing radical hysterectomy is a modified radical hysterectomy, developed to permit resection of oncologically relevant tissues surrounding the cervical lesion, while preserving the pelvic autonomic nerves. OBJECTIVES To evaluate the benefits and harms of nerve-sparing radical hysterectomy in women with stage Ia2 to IIa cervical cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid (1946 to May week 2, 2018), and Embase via Ovid (1980 to 2018, week 21). We also checked registers of clinical trials, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the efficacy and safety of nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). DATA COLLECTION AND ANALYSIS We applied standard Cochrane methodology for data collection and analysis. Two review authors independently selected potentially relevant RCTs, extracted data, evaluated risk of bias of the included studies, compared results and resolved disagreements by discussion or consultation with a third review author, and assessed the certainty of evidence. MAIN RESULTS We identified 1332 records as a result of the search (excluding duplicates). Of the 26 studies that potentially met the review criteria, we included four studies involving 205 women; most of the trials had unclear risks of bias. We identified one ongoing trial.The analysis of overall survival was not feasible, as there were no deaths reported among women allocated to standard radical hysterectomy. However, there were two deaths in among women allocated to the nerve-sparing technique. None of the included studies reported rates of intermittent self-catheterisation over one month following surgery. We could not analyse the relative effect of the two surgical techniques on quality of life due to inconsistent data reported. Nerve-sparing radical hysterectomy reduced postoperative bladder dysfunctions in terms of a shorter time to postvoid residual volume of urine ≤ 50 mL (mean difference (MD) -13.21 days; 95% confidence interval (CI) -24.02 to -2.41; 111 women; 2 studies; low-certainty evidence) and lower volume of postvoid residual urine measured one month following operation (MD -9.59 days; 95% CI -16.28 to -2.90; 58 women; 2 study; low-certainty evidence). There were no clear differences in terms of perioperative complications (RR 0.55; 95% CI 0.24 to 1.26; 180 women; 3 studies; low-certainty evidence) and disease-free survival (HR 0.63; 95% CI 0.00 to 106.95; 86 women; one study; very low-certainty evidence) between the comparison groups. AUTHORS' CONCLUSIONS Nerve-sparing radical hysterectomy may lessen the risk of postoperative bladder dysfunction compared to the standard technique, but the certainty of this evidence is low. The very low-certainty evidence for disease-free survival and lack of information for overall survival indicate that the oncological safety of nerve-sparing radical hysterectomy for women with early stage cervical cancer remains unclear. Further large, high-quality RCTs are required to determine, if clinically meaningful differences of survival exist between these two surgical treatments.
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Affiliation(s)
- Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Apiwat Aue‐aungkul
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Chetta Ngamjarus
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Faculty of Public Health123 Miltraparp RoadKhon KaenKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Baah-Dwomoh A, Alperin M, Cook M, De Vita R. Mechanical Analysis of the Uterosacral Ligament: Swine vs. Human. Ann Biomed Eng 2018; 46:2036-2047. [PMID: 30051246 DOI: 10.1007/s10439-018-2103-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
The uterosacral ligament (USL) is a major suspensory structure of the female pelvic floor, providing support to the cervix and/or upper vagina. It plays a pivotal role in surgical procedures for pelvic organ prolapse (POP) aimed at restoring apical support. Despite its important mechanical function, little is known about the mechanical properties of the USL due to the constraints associated with in vivo testing of human USL and the lack of validated large animal models that enable such investigations. In this study, we provide the first comparison of the mechanical properties of swine and human USLs. Preconditioning and pre-creep data up to a 2 N load and creep data under a 2 N load over 1200 s were obtained on swine (n = 9) and human (n = 9) USL specimens by performing planar equi-biaxial tensile tests and using the digital image correlation method. No differences in the peak strain during preconditioning tests, secant modulus of the pre-creep response, and strain at the end of creep tests were detected in the USLs from the two species along both axial loading directions (the main in vivo loading direction and the direction that is perpendicular to it). These findings suggest that the swine holds promise as large animal model for studying the mechanical role of the USL in apical vaginal support and treatment of POP.
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Affiliation(s)
- Adwoa Baah-Dwomoh
- STRETCH Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, 330 A Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Marianna Alperin
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Mark Cook
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Raffaella De Vita
- STRETCH Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, 330 A Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
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Eid S, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. Comprehensive Review of the Cardinal Ligament. Cureus 2018; 10:e2846. [PMID: 30140597 PMCID: PMC6103387 DOI: 10.7759/cureus.2846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 11/21/2022] Open
Abstract
The cardinal ligament is thought to be one of the important structures in providing support and stabilization for the pelvic organs e.g., the uterus. However, many discrepancies exist in the literature regarding terminology, anatomy, and histology. The cardinal ligament attaches the lateral side of the vagina and cervix to the lateral pelvic wall, which provides support to the vagina and cervix. Studies have shown variable findings in the collagen content and distribution in the cardinal ligaments of women with a prolapsed uterus. Uterine vessels and the branches of the inferior hypogastric plexus travel in the cardinal ligament, which is of great importance during pelvic surgeries. Cervical cancer may lead to metastatic spread to the lymph nodes juxtaposed to the cardinal ligaments. This review aims to highlight the clinical significance and surgical importance of the cardinal ligament with a comparison with previous studies.
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Affiliation(s)
- Seif Eid
- Anatomical Sciences, St. George's University, St. George's, GRD
| | | | - Rod J Oskouian
- Neurosurgery, Swedish Neuroscience Institute, Seattle, USA
| | - Marios Loukas
- Anatomical Sciences, St. George's University, St. George's, GRD
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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Raspagliesi F, Ditto A, Kusamura S, Fontanelli R, Spatti G, Solima E, Zanaboni F, Carcangiu ML. Nerve-Sparing Radical Hysterectomy: A Pilot Study. TUMORI JOURNAL 2018; 89:497-501. [PMID: 14870771 DOI: 10.1177/030089160308900507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nerve-sparing radical hysterectomy has increasingly been used for cervical cancer, with less morbidity. We aimed with this study: i) to describe an alternative technique of nerve-sparing radical Piver III hysterectomy, using the CUSA®, in which attention was given to the uterosacral ligament and cardinal ligament; ii) to evaluate the feasibility of this new nerve-sparing technique; iii) to describe the surgical anatomy of the autonomic nervous system; iv) to assess the early incidence of bladder dysfunction. Twelve consecutive patients with local-regional advanced cervical cancer were enrolled in the study on nerve-sparing radical hysterectomy with extended pelvic lymphadenectomy. The mean age was 44 years (range, 30–59), mean body mass index was 24 kg/m2 (range, 18–30), mean operating time was 217 mins (range, 195–240), and mean blood loss was 437 cc (range, 200–750). The average hospitalization time was 9 days (range, 5–15 days). Two patients presented pathologically positive parametrium. Two of 12 (17%) patients were discharged with self-catheterism. In the first outpatient follow-up, 1 patient had recovered spontaneous voiding. The nerve-sparing technique with CUSA® can be an option to reduce radical hysterectomy-related morbidity. The technique proved to be feasible, with promising results in terms of preventing bladder dysfunction. An elevated body mass index and large tumors can impair the performance of the technique. Further studies clarifying neuroanatomy and neurophysiology of autonomic nervous structures, as well as a prospective controlled trial on nerve-sparing radical hysterectomy should be carried out to confirm our data.
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11
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A Controlled Study on Vaginal Blood Flow During Sexual Arousal Among Early-Stage Cervical Cancer Survivors Treated With Conventional Radical or Nerve-Sparing Surgery With or Without Radiotherapy. Int J Gynecol Cancer 2018; 27:1051-1057. [PMID: 28498243 DOI: 10.1097/igc.0000000000000986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Sexual problems among cervical cancer survivors may in part be caused by reduced vaginal blood flow due to damaged hypogastric nerves during radical hysterectomy with pelvic lymphadenectomy and/or by radiation-induced vaginal changes after pelvic radiotherapy. A nerve-sparing modification of radical hysterectomy (NSRH) may preserve vaginal blood flow. Vaginal blood flow during sexual arousal was compared between different treatment modalities. METHODS We investigated premenopausal women treated for early-stage cervical cancer with radical hysterectomy (n = 29), NSRH (n = 28), NSRH with radiotherapy (n = 14), and controls (n = 31). Genital arousal and subjective sexual arousal in response to sexual stimuli were measured using vaginal photoplethysmography and a questionnaire. Results were compared by using a between-study (treatment groups) by within-study (stimulus) design. RESULTS Participants were aged 29 to 51 years (mean, 42 years) and at 1 to 14 years (mean, 5 years) after treatment. Measured vaginal blood flow in women treated with NSRH was similar to controls. Women treated with radical hysterectomy had a significantly lower vaginal blood flow compared with controls overall and lower compared with the NSRH group during sexual stimulation. Women treated with radiotherapy had a vaginal blood flow intermediate between the other groups without significant differences. The erotic films were equally effective in enhancing subjective sexual arousal among treatment groups. CONCLUSIONS Cervical cancer treatment with radical hysterectomy disrupts the vaginal blood flow response, and this may be prevented by conducting an NSRH. Treatment with radiotherapy did not significantly impact vaginal blood flow, but further investigation is needed with a larger sample.
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Lunniss PJ, Gladman MA, Hetzer FH, Williams NS, Scott SM. Risk Factors in Acquired Faecal Incontinence. J R Soc Med 2017; 97:111-6. [PMID: 14996955 PMCID: PMC1079318 DOI: 10.1177/014107680409700303] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing. Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple). These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.
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Affiliation(s)
- Peter J Lunniss
- Centre for Academic Surgery, Gastrointestinal Physiology Unit, Queen Mary's School of Medicine and Dentistry, Royal London Hospital, Whitechapel, London E1 1BB, UK
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Kietpeerakool C, Aue-aungkul A, Galaal K, Ngamjarus C, Lumbiganon P. Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). Hippokratia 2017. [DOI: 10.1002/14651858.cd012828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chumnan Kietpeerakool
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Apiwat Aue-aungkul
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall Hospital; Gynaecological Oncology; Truro UK TR1 3LJ
| | - Chetta Ngamjarus
- Khon Kaen University; Department of Epidemiology and Biostatistics, Faculty of Public Health; 123 Miltraparp Road Khon Kaen Khon Kaen Thailand 40002
| | - Pisake Lumbiganon
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
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Ramdhan RC, Loukas M, Tubbs RS. Anatomical complications of hysterectomy: A review. Clin Anat 2017; 30:946-952. [PMID: 28762535 DOI: 10.1002/ca.22962] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 01/23/2023]
Abstract
Hysterectomy is the most commonly performed gynecological procedure in the United States with three possible surgical approaches; vaginal, abdominal and laparoscopic. As with any surgical procedure, various anatomical complications can arise. These include injuries to anatomical structures such as the urinary bladder, ureter, intestines, rectum, anus, and a multitude of nervous structures. Other complications include sexual dysfunction, vaginal cuff dehiscence, and urinary incontinence. Using standard search engines, the anatomical complications of hysterectomies are reviewed. In conclusion, surgeons who perform hysterectomies or are involved with postoperative hysterectomy patients should be familiar with the possible complications of this common procedure and the steps that can be taken to help reduce the risk of those complications. Clinicians should also inform their patients of the potential complications as they can affect lifestyle and comfort. Clin. Anat. 30:946-952, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Rebecca C Ramdhan
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.,Seattle Science Foundation, Seattle, Washington
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.,Seattle Science Foundation, Seattle, Washington
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Anatomic relationships of the pelvic autonomic nervous system in female cadavers: clinical applications to pelvic surgery. Am J Obstet Gynecol 2017; 216:388.e1-388.e7. [PMID: 27956200 DOI: 10.1016/j.ajog.2016.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/12/2016] [Accepted: 12/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The integrity of the pelvic autonomic nervous system is essential for proper bowel, bladder, and sexual function. OBJECTIVE The purpose of this study was to characterize the anatomic path of the pelvic autonomic system and to examine relationships to clinically useful landmarks. STUDY DESIGN Detailed dissections were performed in 17 female cadavers. Relationships of the superior hypogastric plexus to aortic bifurcation and midpoint of sacral promontory were examined; the length and width of plexus was documented. Path and width of right and left hypogastric nerves were recorded. The origin and course of the pelvic splanchnic nerves were documented. Individual nerve tissue that contributed to the inferior hypogastric plexus was noted. Relative position of nerves to arteries, viscera, and ligaments was documented. In a subset of specimens, biopsy specimens were obtained to confirm gross findings by histologic analysis. Descriptive statistics were used for data analyses and reporting. RESULTS In all specimens, the superior hypogastric plexus was embedded in a connective tissue sheet within the presacral space, just below the peritoneum. In 14 of 17 specimens (82.4%), the plexus formed a median distance of 21.3 mm (range, 9-40 mm) below aortic bifurcation; in the remaining specimens, it formed a median distance of 25.3 mm (range, 20.5-30 mm) above bifurcation. In 58.8% of specimens, the superior hypogastric plexus was positioned to the left of midline. The median length and width of the plexus was 39.5 (range, 11.5-68) mm and 9 (range, 2.5-15) mm, respectively. A right and left hypogastric nerve was identified in all specimens and formed a median distance of 23 mm (range, 5-32 mm) below the promontory. The median width of the hypogastric nerve was 3.5 mm (range, 3-4.5 mm) on the right and 3.5 mm (range, 2-6.5 mm) on the left. The median distance from midportion of uterosacral ligament to the closest nerve branch was 0.5 mm (range, 0-4.5 mm) on right and 0 mm (range, 0-27.5 mm) on left. In all specimens, the inferior hypogastric plexus was formed by contributions from the hypogastric nerves and branches from S3 and S4. In 47.1% of hemipelvises, S2 branches contributed to the plexus. The sacral sympathetic trunk contributed to the plexus in 16 of 34 hemipelvises where this structure was identified. The inferior hypogastric plexus formed 1-3 cm lateral to the rectum and upper third of the vagina. From this plexus, 1-3 discrete branches coursed deep to the ureter toward the bladder. A uterine branch that coursed superficial to the ureter followed the ascending branch of the uterine artery. An S4 branch was found directly attaching to lateral walls of the rectum in 53% of specimens. Pelvic splanchnic nerves merged into the inferior hypogastric plexus on the lower and medial surface of the coccygeus muscle. Histologic analysis confirmed neural tissue in all tissues that were sampled. CONCLUSION Anatomic variability and inability to visualize the small caliber fibers that comprise the inferior hypogastric plexus grossly likely underlines the reasons that some postoperative visceral and sexual dysfunction occur in spite of careful dissection and adequate surgical technique. These findings highlight the importance of a discussion with patients about the risks that are associated with interrupting autonomic fibers during the preoperative consent.
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Risk of Parametrial Spread in Small Stage I Cervical Carcinoma: Pathology Review of 223 Cases With a Tumor Diameter of 20 mm or Less. Int J Gynecol Cancer 2016; 26:416-21. [PMID: 26745697 DOI: 10.1097/igc.0000000000000604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Considering the morbidity of radical hysterectomy, the advent of fertility-sparing approaches, and the low risk of parametrial involvement in patients with early stage I cervical tumors, the benefit from parametrial resection is debatable. Objectives of this study were to determine factors predicting parametrial tumor spread and to define a group of patients who might be safely spared parametrial resection. METHODS Pathology review was done on patients with stages IA2 and small IB1, treated by radical hysterectomy and pelvic lymph node dissection. Analysis was performed to determine factors associated with parametrial spread and to define risks of obeying parametrial resection. RESULTS A total of 223 patients with tumors less than 20 mm in diameter were identified. Parametrial metastases were documented in 8 patients (3.6%); nodes, 1.3%; lymphovascular space invasion (LVSI), 1.8%; contiguous spread, 0.9%. Of 211 (94.6%) patients with negative pelvic nodes, none had parametrial nodal involvement, 0.9% had LVSI, and 0.4% had contiguous spread. Factors associated with parametrial disease were deep cervical invasion, LVSI, tumor volume, and pelvic lymph node metastases (P < 0.01 for each). In patients without tumor LVSI and the depth of invasion was within the inner third, the rate of parametrial spread was 0.45%. CONCLUSIONS Our data show a risk of parametrial spread of 0.45% for tumors less than 20 mm in diameter, no LVSI, and a depth of invasion within the inner third. Patients wanting fertility preservation might be prepared to take this risk of recurrence. Morbidity after nerve-sparing radical hysterectomy is tolerably low, and for patients in whom fertility preservation is not an issue, this should be considered the standard of care.
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Butler-Manuel SA, Buttery LDK, A'Hern RP, Polak JM, Barton DPJ. Pelvic Nerve Plexus Trauma at Radical and Simple Hysterectomy: A Quantitative Study of Nerve Types in the Uterine Supporting Ligaments. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/107155760200900110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Julia M. Polak
- Division of Gynaecological Oncology, St. George's Hospital, Department of Histochemistry, Imperial College School of Medicine, Department of Computing, The Royal Marsden Hospital, London, United Kingdom
| | - Desmond P. J. Barton
- Division of Gynaecological Oncology, St. George's Hospital, Department of Histochemistry, Imperial College School of Medicine, Department of Computing, The Royal Marsden Hospital, London, United Kingdom
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Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy: a prospective pilot study. Eur J Obstet Gynecol Reprod Biol 2016; 201:131-4. [PMID: 27108122 DOI: 10.1016/j.ejogrb.2016.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to compare pre- and postoperative bladder function and quality of life (QoL) in women diagnosed with gynecologic malignancy and treated with nerve sparing radical hysterectomy (NSRH). STUDY DESIGN Before and after NSRH for uterine malignancy, bladder function was prospectively assessed in a small cohort of 12 women (39-72 years) suffering from uterine malignancy using urodynamic studies and a validated self-administered condition specific QoL questionnaire. Urodynamic studies were performed one day before (U0) as well as one week (U1) and 22 months (U2) after surgery. The questionnaire was applied at U0 and U2. RESULTS Cystometry showed detrusor contractions leading to overactive bladder incontinence in six out of nine women at short-term, which persisted in three women at long-term follow-up leading to a significant impaired QoL. Voiding function and bladder sensation remained uncompromised after surgery. CONCLUSIONS NSRH preserves voiding function and bladder sensation. However, short and long-term urodynamic detrusor overactivity and urge incontinence was observed in a significant number of women although symptoms improved over time. These data are important for counselling women and for the design of larger studies to assess the benefits of NSRH versus conventional radical hysterectomy (RH).
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Serum Androgen Levels and Sexual Function Before and One Year After Treatment of Uterine Cervical Cancer: A Pilot Study. J Sex Med 2016; 13:413-24. [DOI: 10.1016/j.jsxm.2015.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
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Aoun F, Albisinni S, Peltier A, Maoula A, van Velthoven R, Roumeguère T. [Lower urinary tract dysfunction following nerve sparing radical hysterectomy: A systematic review]. Prog Urol 2015; 26:S1166-7087(15)00690-9. [PMID: 26776826 DOI: 10.1016/j.purol.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Radical hysterectomy represents the cornerstone in the management of localized cervical cancer. Despite its oncologic efficacy, radical hysterectomy is associated with a significant amount of complications and a negative impact on quality of life. Surgical technique seems to influence the functional outcomes. AIM OF THE STUDY A systematic review to provide an update on the lower urinary tract dysfunction following nerve sparing radical hysterectomy. METHODS An initial search was carried out to identify articles for further review, using Cochrane reviews and PubMed and Embase databases. The search terms used were: "nerve sparing" and "cervical cancer" or "radical hysterectomy". The Preferred Reporting Items for Systematic Reviews and Meta-Analyses process for reporting included and excluded studies was followed, with the recommended flowchart showing the numbers of papers identified and included or excluded at each stage. RESULTS Twenty-nine clinical studies were included. The absence of a standardized surgical technique for nerve sparing radical hysterectomy and the poor methodological quality of the studies assessing lower urinary tract dysfunction after such intervention limited clear conclusions. However, all studies reported lower incidence of urinary tract dysfunction, urodynamic abnormalities and clean intermittent catheterization following nerve sparing radical hysterectomy compared to conventional technique. CONCLUSION Nerve sparing radical hysterectomy is associated with reduced lower urinary tract dysfunction. A standardization of the surgical technique for nerve sparing radical hysterectomy, tailored to each individual is necessary to allow its wide spread diffusion.
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Affiliation(s)
- F Aoun
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique.
| | - S Albisinni
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - A Peltier
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - A Maoula
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - R van Velthoven
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - T Roumeguère
- Service d'urologie, université Libre de Bruxelles, hôpital Erasme, cliniques universitaires de Bruxelles, Bruxelles, Belgique
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Abstract
INTRODUCTION Hysterectomy has been a mainstay of gynecologic therapy for 100 years. It can be postulated that hysterectomy could affect female sexual function due to psychological factors, and also due to disruption of the local nerve and blood supply and the intimate anatomical relationships of the pelvic organs. AIM To evaluate the effects of hysterectomy performed for benign conditions on female sexual function. METHODS Peer-reviewed publications were identified through a PubMed search using the search terms "hysterectomy," "benign," "sexual function," "dyspareunia," "orgasm," "libido," and "dysfunction." The search was completed through to February 2015 and was limited to articles published in English. MAIN OUTCOME MEASURE The main outcome measure was sexual function after hysterectomy for benign conditions. As hysterectomy is performed via various routes, abdominal (open and laparoscopic) and vaginal, sexual function in each group was evaluated. RESULTS Studies were of varying methodology. Majority of women demonstrated either unchanged or improved sexual function after hysterectomy performed by any route in the short term. A significant minority of women reported sexual dysfunction following hysterectomy. Deterioration in sexual function was found on long-term follow-up, which is probably an effect of aging and bilateral salpingo-oophorectomy. There were no proven benefits supracervical compared with total hysterectomy either in the short term (up to 2 years postsurgery) or long term (up to 15 years after hysterectomy). CONCLUSIONS Women can be positively reassured that hysterectomy does not negatively affect sexuality. Health professions should be aware that a minority of women may develop adverse effects after the operation. Preoperative education about the potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes are experienced. Thakar R. Is the uterus a sexual organ? Sexual function following hysterectomy.
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Affiliation(s)
- Ranee Thakar
- Department of Obstetrics and GynaecologyUrogynaecology and Pelvic Floor Reconstruction UnitCroydon University HospitalCroydonUK.
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Laterza RM, Salvatore S, Ghezzi F, Serati M, Umek W, Koelbl H. Urinary and anal dysfunction after laparoscopic versus laparotomic radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 2015; 194:11-6. [PMID: 26313524 DOI: 10.1016/j.ejogrb.2015.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/15/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare urinary and anal dysfunction after laparoscopic (LRH) and abdominal (ARH) radical hysterectomy for cervical cancer. STUDY DESIGN Consecutive patients who underwent radical hysterectomy for treatment of cervical cancer were enrolled in this study and divided into two groups, according to the surgical approach. Urinary and anal symptoms were evaluated before and 6 months after surgery. RESULTS Fifty-four women were considered: 27 LRH and 27 ARH. Urinary incontinence was significantly more frequent both after LRH (37% vs 86.9%, p=0.0004) and after ARH (33.3% vs 100%, p<0.0001); urge incontinence (3.7% vs 29.6%, p=0.02) and increased bladder sensation (0 vs 22.2%, p=0.02) were significantly more common postoperatively in patients undergone ARH. In both groups more patients complain about increase of straining during voiding (LRH: 0 vs 34.7%, p=0.009; ARH: 3.7% vs 29.6% p=0.02) after surgery. Postoperative constipation by obstructed defecation was more frequent after ARH (Wexner score: 0 vs 2, p=0.03) but not after LRH. CONCLUSION From our results, laparoscopic approach for radical hysterectomy seems to reduce the postoperative occurrence of urge incontinence, increased bladder sensation and constipation by obstructed defecation, in comparison with abdominal radical surgery.
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Affiliation(s)
- Rosa M Laterza
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria; Department of Obstetrics and Gynaecology, Insubria University, Varese, Italy.
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, Vita Salute University School of Medicine San Raffaele Scientific Institute, Milano, Italy; Department of Obstetrics and Gynaecology, Insubria University, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, Insubria University, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, Insubria University, Varese, Italy
| | - Wolfgang Umek
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria
| | - Heinz Koelbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria
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Lower urinary tract dysfunction in pelvic gynecologic cancer: the role of urodynamics. Adv Urol 2014; 2014:303958. [PMID: 25506360 PMCID: PMC4259142 DOI: 10.1155/2014/303958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
The exact incidence of lower urinary tract dysfunction is not known and its pathogenesis is not completely understood. Advances in urodynamic assessment and widespread availability of a standardized technique have facilitated its exploration prior to and subsequent to the surgical management of patients with gynecologic pelvic cancer. We performed a PubMed and Medline literature search using the following keywords: bladder dysfunction, urinary dysfunction, and urodynamics and all these terms in combination with radical hysterectomy in order to analyze the role of urodynamics in patients with pelvic gynecologic cancer in the preoperative as well as in the early and late postoperative settings.
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Aoun F, van Velthoven R. Lower urinary tract dysfunction after nerve-sparing radical hysterectomy. Int Urogynecol J 2014; 26:947-57. [PMID: 25432634 DOI: 10.1007/s00192-014-2574-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/04/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this review is to provide a comprehensive overview of the current role of nerve-sparing radical hysterectomy (NSRH) in reducing the incidence of postoperative lower urinary tract dysfunction (LUTD) and in improving quality of life. METHODS A detailed online search was performed using the following keywords: nerve sparing, radical hysterectomy, cervical cancer, and all these terms in combination with urinary dysfunction or bladder dysfunction in order to analyze the effect of NSRH on urinary functional outcomes. Articles retrieved were analyzed and assigned a level of evidence (LE) according to the criteria of the Centre for Evidence-Based Medicine in Oxford, UK. RESULTS Our review highlights the heterogeneity of conducting and reporting studies in the literature. Autonomic pelvic nerve injuries during the procedure are thought to be the major cause of LUTD. The amount of LUTD depends upon the extent and type of nerve injury. Anatomically based surgical techniques are developed to avoid nerve injury without compromising oncological control. All studies comparing NSRH to standard RH yielded promising results with respect to postoperative LUTD. A recent meta-analysis showed similar cancer control rates between the two techniques. However, controversies remain about the ideal surgical approach for nerve sparing and there is no consensus as to the level and landmarks of dissection to preserve the maximal amount of nerves without compromising oncological outcomes. CONCLUSIONS Available evidence suggests that NSRH is safe and associated with lower incidence of LUTD. However, there is no standardized technique for NSRH and controversies remain about its oncological safety. Long-term oncological data from multicenter surgical trials are needed as well as a universally accepted standard to report studies on NSRH.
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Affiliation(s)
- Fouad Aoun
- Urology Department, Jules Bordet Institute, 1 Héger Bordet Street, 1000, Brussels, Belgium,
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25
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Ballester M, Dubernard G, Wafo E, Bellon L, Amarenco G, Belghiti J, Daraï E. Evaluation of urinary dysfunction by urodynamic tests, electromyography and quality of life questionnaire before and after surgery for deep infiltrating endometriosis. Eur J Obstet Gynecol Reprod Biol 2014; 179:135-40. [DOI: 10.1016/j.ejogrb.2014.05.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/19/2014] [Accepted: 05/28/2014] [Indexed: 11/27/2022]
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Lim VF, Khoo JK, Wong V, Moore KH. Recent studies of genetic dysfunction in pelvic organ prolapse: the role of collagen defects. Aust N Z J Obstet Gynaecol 2014; 54:198-205. [PMID: 24575973 DOI: 10.1111/ajo.12169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/16/2013] [Indexed: 12/13/2022]
Abstract
Gynaecologists are becoming increasingly aware that women with a family history of prolapse are at an increased risk of prolapse refractory to treatment. In the past five years, several genetic mutations have been shown to correlate with increased prolapse susceptibility. These mutations can result in disordered collagen metabolism, which weaken the fascial support of the pelvic organs. This review examines the contemporary evidence regarding the role of collagen in prolapse.
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Affiliation(s)
- Veronica F Lim
- Pelvic Floor Unit, St George Hospital/University of New South Wales, Sydney, NSW, Australia
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27
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Laterza RM, Sievert KD, de Ridder D, Vierhout ME, Haab F, Cardozo L, van Kerrebroeck P, Cruz F, Kelleher C, Chapple C, Espuña-Pons M, Koelbl H. Bladder function after radical hysterectomy for cervical cancer. Neurourol Urodyn 2014; 34:309-15. [PMID: 24519734 DOI: 10.1002/nau.22570] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 01/08/2014] [Indexed: 11/06/2022]
Abstract
AIM To report the effects of radical hysterectomy and nerve-sparing techniques on lower urinary tract function in women. METHODS A literature search was performed in Pubmed and Medline using the keywords bladder after radical hysterectomy, nerve sparing radical hysterectomy, and urinary dysfunction following radical hysterectomy. Significant results and citations were reviewed manually by the authors. RESULTS The sympathetic and parasympathetic systems innervating the lower urinary tract may be disrupted due to resection of uterosacral and rectovaginal ligaments, the dorsal and lateral paracervix, the caudal part of the vesico-uterine ligaments, and the vagina. This supports the neurogenic etiology of early and late bladder dysfunction after radical surgery. Bladder disorders are also related to the extent of radical surgery. The neuropathopysiology of lower urinary tract symptoms after radical hysterectomy is not fully understood. Recent data have highlighted the role of urethral sphincter pressure in the etiology of postoperative incontinence. Various surgical approaches have been developed to preserve autonomic pelvic innervation. CONCLUSIONS Nerve-sparing techniques appear to improve bladder function without compromising overall survival. Studies comparing the effects of nerve-sparing radical hysterectomy with standard surgery yielded encouraging results in respect of postoperative lower urinary tract function. Clinical trials with a long period of follow-up are required for better comprehension of the complex pathophysiology of bladder dysfunction after radical hysterectomy.
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Affiliation(s)
- Rosa M Laterza
- Division of Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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Chen C, Huang L, Liu P, Su G, Li W, Lu L, Wang L, Li X, Duan H, Zou C, Hatch K. Neurovascular quantitative study of the uterosacral ligament related to nerve-sparing radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 2014; 172:74-9. [DOI: 10.1016/j.ejogrb.2013.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/06/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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Serati M, Cattoni E, Braga A, Uccella S, Cromi A, Ghezzi F. Deep endometriosis and bladder and detrusor functions in women without urinary symptoms: a pilot study through an unexplored world. Fertil Steril 2013; 100:1332-6. [PMID: 23891020 DOI: 10.1016/j.fertnstert.2013.06.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 11/17/2022]
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Samaan A, Vu D, Haylen BT, Tse K. Cardinal ligament surgical anatomy: cardinal points at hysterectomy. Int Urogynecol J 2013; 25:189-95. [DOI: 10.1007/s00192-013-2248-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
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Ahn JY, Myung SJ, Jung KW, Yang DH, Koo HS, Seo SY, Yoon IJ, Kim KJ, Ye BD, Byeon JS, Jung HY, Yang SK, Kim JH. Effect of biofeedback therapy in constipation according to rectal sensation. Gut Liver 2013; 7:157-62. [PMID: 23560150 PMCID: PMC3607768 DOI: 10.5009/gnl.2013.7.2.157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/04/2012] [Accepted: 05/30/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS The pathophysiologic mechanism of rectal hyposensitivity (RH) is not well documented, and the significance of RH in biofeedback therapy (BFT) has not been evaluated. Thus, we aimed to assess the effect of BFT in constipated patients according to the presence of RH. METHODS Five hundred and ninety constipated patients (238 males and 352 females) underwent anorectal physiologic assessments. Of these, anorectal manometry was performed before and after BFT in 244 patients (63 RH and 181 non-RH patients). RESULTS The success rate of BFT was 56% in the RH and 61% in the non-RH group (p=0.604). The measurements of resting pressure, squeezing pressure, desire to defecate volume, urge to defecate volume, and maximum volume were decreased after BFT in the RH group (p<0.05), whereas only resting and squeezing pressures were decreased in the non-RH group (p<0.05). Among the RH group, individuals who responded to BFT showed decreased resting pressure, squeezing pressure, desire to defecate, urge to defecate, and maximum volume and increased balloon expulsion rate; among those who did not respond to BFT, only desire to defecate volume was improved. CONCLUSIONS In constipated patients with RH, changes of anorectal manometric findings differed in comparison to patients without RH. The responses to BFT showed both anorectal muscle relaxation and restoration of rectal sensation.
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Affiliation(s)
- Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chen L, Ramanah R, Hsu Y, Ashton-Miller JA, Delancey JOL. Cardinal and deep uterosacral ligament lines of action: MRI based 3D technique development and preliminary findings in normal women. Int Urogynecol J 2013; 24:37-45. [PMID: 22618207 PMCID: PMC3986864 DOI: 10.1007/s00192-012-1801-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The cardinal ligament (CL) and deep uterosacral ligament (US) play a critical role in utero-vaginal support. This study aims to quantify their geometrical relationships in living women using a MRI-based 3D technique. METHODS The angles between ligaments, the ligaments length and curvature were assessed on 3D models constructed from twenty MRIs of volunteers with normal support. How angle variation theoretically affects ligament tension was investigated using a simplified biomechanical model. RESULTS The CLs are 18.1 ° ± 6.8 °(SD) from the cephalic-caudal body axis , and the USs are dorsally directed and 92.5 ° ± 13.5 from the body axis. The CLs are longer and more curved than US. The theoretical calculated tension on CL is 52 % larger than that on US. CONCLUSIONS The CL is relatively parallel to the body axis while the US is dorsally directed. The tensions on these ligaments are affected by their orientations.
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Affiliation(s)
- Luyun Chen
- Departments of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Bitzer J, Giraldi A, Pfaus J. Sexual Desire and Hypoactive Sexual Desire Disorder in Women. Introduction and Overview. Standard Operating Procedure (SOP Part 1). J Sex Med 2013; 10:36-49. [DOI: 10.1111/j.1743-6109.2012.02818.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Tseng CJ, Shen HP, Lin YH, Lee CY, Wei-Cheng Chiu W. A prospective study of nerve-sparing radical hysterectomy for uterine cervical carcinoma in Taiwan. Taiwan J Obstet Gynecol 2012; 51:55-9. [PMID: 22482969 DOI: 10.1016/j.tjog.2012.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Surgical therapy for cervical carcinoma carries a significant risk of functional impairment to the bladder. This study evaluates the feasibility and complications of nerve-sparing radical hysterectomy (NRH) in Taiwan. METHODS Between March 2010 and March 2011, consecutive patients diagnosed with early stage cervical cancer (FIGO stage Ia2 to Ib1) and tumor size < 3 cm were recruited prospectively to undergo NRH or conventional radical hysterectomy (RH). Patients with histories of urinary stress incontinence or bladder dysfunction disease were excluded. A modified Tokyo nerve-sparing radical hysterectomy was performed. RESULTS A total of 30 patients were enrolled. Among these, 18 patients underwent NRH with successful bilaterally nerve-sparing procedures in 15 cases (83%), unilaterally nerve-sparing procedures in 2 cases (11%), and a failure in 1 case (6%). The indwelling catheter was removed on postoperative day 6. The mean±SD duration from operation to spontaneous voiding was 6.8 ± 1.5 days for women who underwent NRH; the corresponding duration for women who underwent RH or failed NRH was 20.6 ± 3 days. None of the patients who underwent NRH required intermittent catheterization. All 12 patients who underwent RH needed self-catheterization after discharge. There was a significant reduction in the incidence of postoperative self-catheterization (p<0.01) and bladder dysfunction (p<0.006). Average satisfaction score analyzed by the Likert-scale questionnaire was 4.5 for the NRH group and 1.9 for RH group (p<0.0001). CONCLUSIONS We concluded that the new technique of NRH can reduce postoperative bladder dysfunctions.
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Affiliation(s)
- Chih-Jen Tseng
- Department of Obstetrics and Gynecology, Chung Shang Medical University Hospital, Taiwan.
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Lakeman MME, The S, Schellart RP, Dietz V, ter Haar JF, Thurkow A, Scholten PC, Dijkgraaf MGW, Roovers JPWR. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012; 119:1473-82. [DOI: 10.1111/j.1471-0528.2012.03484.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Nobbenhuis MAE, Balasubramani L, Kolomainen DF, Barton DPJ. Surgical management and follow-up of patients with cervical cancer: Survey of gynaecological oncologists in the UK. J OBSTET GYNAECOL 2012; 32:576-9. [DOI: 10.3109/01443615.2012.694510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rob L, Robova H, Chmel R, Komar M, Halaska M, Skapa P. Surgical options in early cervical cancer. Int J Hyperthermia 2012; 28:489-500. [DOI: 10.3109/02656736.2012.675116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments. Int Urogynecol J 2012; 23:1483-94. [PMID: 22618209 DOI: 10.1007/s00192-012-1819-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/24/2012] [Indexed: 01/01/2023]
Abstract
The objective of this work was to collect and summarize relevant literature on the anatomy, histology, and imaging of apical support of the upper vagina and the uterus provided by the cardinal (CL) and uterosacral (USL) ligaments. A literature search in English, French, and German languages was carried out with the keywords apical support, cardinal ligament, transverse cervical ligament, Mackenrodt ligament, parametrium, paracervix, retinaculum uteri, web, uterosacral ligament, and sacrouterine ligament in the PubMed database. Other relevant journal and textbook articles were sought by retrieving references cited in previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends from the S2 to the S4 vertebra region to the dorsal margin of the uterine cervix and/or to the upper third of the posterior vaginal wall. It has a superficial and deep component. Autonomous nerve fibers are a major constituent of the deep USL. CL is defined as a perivascular sheath with a proximal insertion around the origin of the internal iliac artery and a distal insertion on the cervix and/or vagina. It is divided into a cranial (vascular) and a caudal (neural) portions. Histologically, it contains mainly vessels, with no distinct band of connective tissue. Both the deep USL and the caudal CL are closely related to the inferior hypogastric plexus. USL and CL are visceral ligaments, with mesentery-like structures containing vessels, nerves, connective tissue, and adipose tissue.
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Classical and nerve-sparing radical hysterectomy: An evaluation of the nerve trauma in cardinal ligament. Gynecol Oncol 2012; 125:245-51. [DOI: 10.1016/j.ygyno.2011.12.448] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/20/2011] [Accepted: 12/22/2011] [Indexed: 11/17/2022]
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Plotti F, Nelaj E, Sansone M, Antonelli E, Altavilla T, Angioli R, Benedetti Panici P. Sexual Function after Modified Radical Hysterectomy (Piver II/Type B) vs. Classic Radical Hysterectomy (Piver III/Type C2) for Early Stage Cervical Cancer. A Prospective Study. J Sex Med 2012; 9:909-17. [DOI: 10.1111/j.1743-6109.2011.02581.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bladder Dysfunction after Gynecologic Laparoscopic Surgery for Benign Disease. J Minim Invasive Gynecol 2012; 19:76-80. [DOI: 10.1016/j.jmig.2011.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/21/2011] [Accepted: 09/27/2011] [Indexed: 11/15/2022]
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Kaplan PB, Usta U, Inal HA, Tastekin E, Tastekin T, Tokuc B. Neuromuscular morphometry of the uterine ligaments and vaginal wall in women with pelvic organ prolapse. Neurourol Urodyn 2011; 30:126-32. [PMID: 21046656 DOI: 10.1002/nau.20972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS The aim of this study was to compare neuromuscular histomorphometry of the uterine ligaments and vaginal wall in women with and without pelvic organ prolapse. METHODS Biopsies were obtained from the round, uterosacral, and cardinal ligaments of the uterus and apical vaginal wall of women having pelvic organ prolapse repaired (stage ≥ II; prolapse group, 37) and the same location in patients with no prolapse (stage < II; control group, 47). Routine hematoxylin-eosin (H & E) staining and immunohistochemical staining for Protein Gene Product 9.5 (PGP 9.5) and smooth muscle α-actin were performed for all specimens. RESULTS Smooth muscle percentage of the uterosacral and cardinal ligaments were not significantly different in women with prolapse than in women without. In round ligament, mean smooth muscle percentage was lower than in women with normal support (81.63 ± 8.2 vs. 51.63 ± 16, P=0.000). Mean distance of the smooth muscle fibers from surface epithelium of the vaginal epithelium of the women with prolapse were significantly higher than the control group (1.679 ± 0.34 vs. 2.240 ± 0.33, P = 0.000). PGP 9.5 stained area percentage of uterine ligaments and vaginal wall tissue samples were significantly lower in women with prolapse. CONCLUSIONS Both total innervation of the anterior vaginal epithelium and uterine ligaments, and muscular percentage of the round ligament and vaginal wall were decreased in women with pelvic organ prolapse.
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Affiliation(s)
- Petek Balkanli Kaplan
- Department of Obstetric & Gynecology, Trakya University Medical Faculty, Edirne, Turkey.
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Robotic nerve-sparing radical hysterectomy: Feasibility and technique. Gynecol Oncol 2011; 121:605-9. [DOI: 10.1016/j.ygyno.2011.02.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 02/08/2011] [Accepted: 02/22/2011] [Indexed: 11/20/2022]
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Ballester M, Chereau E, Dubernard G, Coutant C, Bazot M, Daraï E. Urinary dysfunction after colorectal resection for endometriosis: results of a prospective randomized trial comparing laparoscopy to open surgery. Am J Obstet Gynecol 2011; 204:303.e1-6. [PMID: 21256472 DOI: 10.1016/j.ajog.2010.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/03/2010] [Accepted: 11/02/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate urinary symptoms before and after colorectal resection for endometriosis using validated questionnaires. STUDY DESIGN We randomly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection. The median follow-up was 19 months. Urinary symptoms were evaluated using the International Prostate Score Symptom and the Bristol Female Low Urinary Tract Symptoms questionnaires. RESULTS Dysuria was observed in 29% of cases postoperatively. Using Bristol Female Low Urinary Tract Symptoms and International Prostate Score Symptom scores, an alteration was observed for voiding symptoms (P = .01 and P = .006, respectively). No difference was observed between the laparoscopy and the open surgery group. An alteration of the International Prostate Score Symptom voiding symptoms was observed in the group that did not undergo nerve sparing surgery (P = .048). An alteration of the International Prostate Score Symptom voiding symptoms was observed for patients who underwent vaginal resection (P = .01) and parametrial resection (P = .02). CONCLUSION Our findings confirm that colorectal resection for endometriosis is a source of urinary dysfunction whatever the surgical route.
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Kavallaris A, Dafopoulos A. Response to the letter entitled “Bladder function after laparoscopic nerve-sparing radical hysterectomy”, by Dr. F. Plotti et al. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kovoor E, Nassif J, Miranda-Mendoza I, Lang-Avérous G, Wattiez A. Long-term urinary retention after laparoscopic surgery for deep endometriosis. Fertil Steril 2011; 95:803.e9-12. [DOI: 10.1016/j.fertnstert.2010.07.1043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 06/26/2010] [Accepted: 07/08/2010] [Indexed: 11/26/2022]
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Scott SM, van den Berg MM, Benninga MA. Rectal sensorimotor dysfunction in constipation. Best Pract Res Clin Gastroenterol 2011; 25:103-18. [PMID: 21382582 DOI: 10.1016/j.bpg.2011.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 01/03/2011] [Indexed: 01/31/2023]
Abstract
The pathophysiological mechanisms underlying chronic constipation in both adults and children remain to be unravelled. This is a not inconsiderable challenge, but is fundamental to improving management of such patients. Rectal sensorimotor function, which encompasses both sensation and motility, as well as biomechanical components (compliance, capacity), is now strongly implicated in the pathogenesis of constipation. Rectal hyposensitivity, rectal hypercompliance, increased rectal capacity, rectal motor dysfunction (phasic contractility and tone), and altered rectoanal reflex activity are all found in constipated patients, particularly in association with 'functional' disorders of defaecation (i.e. pelvic floor dyssynergia). This review covers contemporary understanding of how components of rectal sensorimotor function may contribute to symptom development in both adult and paediatric populations. The complex interaction between sensory/motor/biomechanical domains, and how best to measure these functions are addressed, and where data exist, the impact of sensorimotor dysfunction on therapeutic outcomes is highlighted.
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Affiliation(s)
- S M Scott
- Academic Surgical Unit & Neurogastroenterology Group, Barts and The London School of Medicine and Dentistry, Queen Mary University London, United Kingdom.
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Moszkowicz D, Alsaid B, Bessede T, Penna C, Benoit G, Peschaud F. Female pelvic autonomic neuroanatomy based on conventional macroscopic and computer-assisted anatomic dissections. Surg Radiol Anat 2011; 33:397-404. [PMID: 21225426 DOI: 10.1007/s00276-010-0773-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/23/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To confront nerve dissection, tissue staining, nerve immunolabelling and Computer-Assisted Anatomic Dissection (CAAD) in identifying the precise location and origin of intrapelvic autonomic nerve fibers and to provide a three-dimensional (3D) representation of their relationship to other anatomical structures. METHODS Serial transverse sections of the pelvic portion of five human female fetuses (18-31 weeks of gestation) were studied histologically (with hematoxylin/eosin and Masson trichrome) and immunohistochemically (anti-protein S100 antibody) digitized and reconstructed three-dimensionally with Surf driver software for Windows (Winsurf 4.3). Three fresh female adult cadavers were macroscopically dissected to individualize the inferior hypogastric plexus afferences and efferences and their anatomical relationships. RESULTS This combined investigation including the CAAD technique allowed identifying the precise location and distribution of the pelvic nerve elements and their relationships to female pelvic organs. Hypogastric nerves (HN) were located in the retrorectal multilaminar structure and joined the homolateral inferior hypogastric plexus (IHP) at the lateral border of the recto-uterine pouch. The intersection of the ureter with the posterior wall of the uterine artery precisely located the junction of HN and IHP. Antero-inferior branches supplying female sexual and continence organs originated from the antero-inferior angle of IHP and were bundled at the posterolateral vaginal wall. CONCLUSIONS CAAD is an encouraging anatomical method for the development of anatomical and surgical research and teaching. Complementary to traditional anatomical studies, it may provide useful anatomical data for the comprehension of postoperative sexual and urinary dysfunction and the development of nerve-sparing surgical techniques.
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Affiliation(s)
- David Moszkowicz
- Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
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Cam C, Celik C, Yildirim G, Tug N, Cam M, Karateke A. Responsiveness of urogynecologic quality of life measurements to change after radical gynecologic surgery. Arch Gynecol Obstet 2010; 284:1259-63. [PMID: 21188400 DOI: 10.1007/s00404-010-1823-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 11/23/2010] [Indexed: 11/25/2022]
Abstract
AIM In order to assess the responsiveness of short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) in a subset of women undergoing radical operations for gynecologic cancer. MATERIALS AND METHODS Women with cervical cancer without any abnormal urodynamic abnormalities who had undergone Class III hysterectomy were included in the study. All women underwent urodynamic investigation and completed the IIQ-7 and UDI-6 questionnaires pre-operatively and post-operatively in the sixth month. Twenty-eight patients were enrolled and general and subscale scores of the questionnaire were calculated in the study between February 2008 and September 2008. RESULTS Class III hysterectomy was performed in 28 women with stage Ib cervical carcinoma. Scores of IIQ-7 and the irritative and obstructive subscales of UDI-6 in the sixth post-operative month were significantly higher than the pre-operative scores. The Cronbach's α was 0.84. Cystometric parameters were in concordance with these changes in the questionnaire scores. CONCLUSION The IIQ-7 and UDI-6 questionnaires are sensitive to changes in patients who have undergone radical oncologic operations because their life impact of incontinence may be affected. Validated questionnaires are reasonable measures to detect these changes, which are confirmed by urodynamic findings.
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Affiliation(s)
- Cetin Cam
- Department of Obstetrics and Gynecology, Zeynep Kamil teaching hospital, Ahcibasi mahallesi, Arakiyeci sokak 45/8 Uskudar, Istanbul, Turkey.
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Charoenkwan K. A simplified technique for nerve-sparing type III radical hysterectomy: by reorganizing their surgical sequence, surgeons could more easily identify key nerves. Am J Obstet Gynecol 2010; 203:600.e1-6. [PMID: 21111111 DOI: 10.1016/j.ajog.2010.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 09/07/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
Nerve-sparing radical hysterectomy was developed in an attempt to minimize complications, including bladder, colorectal, and sexual dysfunction which are associated with disruption of the pelvic autonomic nerves during resection of the parametrium. In this article, the author proposes a simple, effective technique for identification and preservation of the pelvic nerves during type III radical hysterectomy. The essential technical considerations include the sequential approach to parametrial resection, starting from the posterior part, the direct visualization of the main nerve trunks at all sites during parametrial resection, and the avoidance of direct manipulation and unnecessary dissection of the nerves. Operative outcomes of 22 patients with cervical or uterine cancer who underwent type III radical hysterectomy from August 2008 to March 2010 were reviewed. Comparing with the earlier method performed at the author's institution, the present technique was associated with an increased proportion of patients who had a postvoid residual urine volume (PVR) under 50 mL at postoperative day 7 (55% vs 27%) and a shorter median duration before this PVR was reached (7 days vs 9 days). The systematic approach proposed in this article would make the nerve-sparing technique for radical hysterectomy more straightforward and applicable to various settings. A thorough understanding of anatomy and adequate surgical skills are always vital components of successful nerve-sparing radical hysterectomy.
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