1
|
Cai L, Wu Y, Xu X, Cao J, Li D. Pelvic floor dysfunction in gynecologic cancer survivors. Eur J Obstet Gynecol Reprod Biol 2023; 288:108-113. [PMID: 37499277 DOI: 10.1016/j.ejogrb.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/06/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
Pelvic floor dysfunction (PFD) is a common complication in gynecologic cancer survivors (GCS) and is now a worldwide medical and public health problem because of its great impact on the quality of life of GCS. PFD after comprehensive gynecologic cancer treatment is mainly reflected in bladder function, rectal function, sexual dysfunction and pelvic organ prolapse (POP), of which different types of gynecologic cancer correspond to different disease incidence. The prevention strategies of PFD after comprehensive gynecologic cancer treatment mainly included surgical treatment, physical therapy and behavioral guidance, etc. At present, most of them still focus on physical therapy, mostly using Pelvic Floor Muscle Training (PFMT) and multi-modal PFMT treatment of biofeedback combined with electrical stimulation, which can reduce the possibility of PFD after surgery in GCS to some extent. This article reviews the clinical manifestations, causes and current research progress of prevention and treatment methods of PFD after comprehensive treatment for GCS.
Collapse
Affiliation(s)
- Linjuan Cai
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Yue Wu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Xuyao Xu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Jian Cao
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
| | - Dake Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
| |
Collapse
|
2
|
Wang L, Liu P, Duan H, Li P, Li W, Chen C. Evaluation of individualized para-tumor resection of cervical cancer patients based on three-dimensional reconstruction. Front Surg 2023; 10:1174490. [PMID: 37181590 PMCID: PMC10174429 DOI: 10.3389/fsurg.2023.1174490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Objective To discuss the possibility of individualizing the para-tumor resection range (PRR) in cervical cancer patients based on three-dimensional (3D) reconstruction. Methods We retrospectively included 374 cervical cancer patients who underwent abdominal radical hysterectomy. Preoperative computerized tomography (CT) or magnetic resonance imaging (MRI) data sets were collected to get 3D models. Postoperative specimens were measured to evaluate surgical scope. Oncological outcomes of patients with different depths of stromal invasion and PRR were compared. Results A PRR of 32.35 mm was found to be the cut-off point. For the 171 patients with stromal invasion <1/2 depth, patients with a PRR over 32.35 mm had a lower risk of death and higher 5-year overall survival (OS) than that in the ≤32.35 mm group (HR = 0.110, 95% CI: 0.012-0.988, P = 0.046; OS: 98.8% vs. 86.8%, P = 0.012). No significant differences were found in 5-year disease-free survival (DFS) between the two groups (92.2% vs. 84.4%, P = 0.115). For the 178 cases with stromal invasion ≥1/2 depth, no significant differences were found in 5-year OS and DFS between groups (≤32.35 mm group vs. >32.35 mm group, OS: 71.0% vs. 83.0%, P = 0.504; DFS: 65.7% vs. 80.4%, P = 0.305). Conclusion In patients with stromal invasion <1/2 depth, the PRR should reach 32.35 mm to get more survival benefit and in patients with stromal invasion ≥1/2 depth, the PRR should reach 32.35 mm at least to avoid worse prognosis. Cervical cancer patients with different depths of stromal invasion may receive tailoring resection of the cardinal ligament.
Collapse
Affiliation(s)
- Lu Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Duan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Chunlin Chen
| |
Collapse
|
3
|
Casas-Nebra J, Blanco-Gomez B, Medina-González A, Formoso-Garcia I, Escaf-Barmadah S, Alvarez-Arenal A. Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy. Actas Urol Esp 2022; 46:431-441. [PMID: 35339398 DOI: 10.1016/j.acuroe.2022.03.003] [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: 05/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. MATERIALS AND METHODS The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. RESULTS Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. CONCLUSIONS The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.
Collapse
Affiliation(s)
- J Casas-Nebra
- Servicio de Urología, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - B Blanco-Gomez
- Servicio de Urología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - A Medina-González
- Servicio de Urología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - I Formoso-Garcia
- Service de Oncología Radioterápica, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - S Escaf-Barmadah
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Cirugía y Especialidades Medicoquirúrgicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | - A Alvarez-Arenal
- Departamento de Cirugía y Especialidades Medicoquirúrgicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
4
|
Casas-Nebra J, Blanco-Gomez B, Medina-González A, Formoso-Garcia I, Escaf-Barmadah S, Alvarez-Arenal A. Impacto de la prostatectomía radical en los resultados urodinámicos de pacientes con cáncer de próstata tratados con radioterapia de intensidad modulada. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Chou MH, Meng E, Wu ST, Cha TL, Sun GH, Yu DS, Chung CH, Chien WC. Increased incidence of neurogenic bladder after radical hysterectomy for cervical cancer: A nationwide population-based cohort study. J Chin Med Assoc 2021; 84:942-950. [PMID: 34613942 DOI: 10.1097/jcma.0000000000000613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The effect of radical hysterectomy for patients with cervical cancer on voiding function remains controversial. The purpose of this study was to examine the association between radical hysterectomy for patients with cervical cancer and the odds of developing neurogenic bladder by using data from the National Health Insurance Research Database (NHIRD) in Taiwan. METHODS We identified 17 936 patients who underwent radical hysterectomy for cervical cancer between 2000 and 2013 among inpatients registered in the Longitudinal Health Insurance Database in Taiwan. Of the patients, those diagnosed as having cervical cancer without radical hysterectomy were selected and compared as a matched control group. Patients diagnosed as having cervical cancer before the index date, those with neurogenic bladder dysfunction before tracking, and those aged <20 years were excluded. The hazard ratios (HRs) of neurogenic bladder and other variants of interest were further calculated using a multivariate Cox regression analysis. The cutoff p value of <0.05 was regarded as statistically significant. RESULTS The adjusted HR (aHR) of subsequent neurogenic bladder was higher in the hysterectomy group (aHR = 1.205; 95% CI, 1.086-1.440; p = 0.029) than in the control group during the follow-up period. As to the age subgroups, the patients aged 20 to 44 years (aHR = 3.321, p = 0.001) had a significantly increased risk of developing neurogenic bladder after radical hysterectomy as compared with those aged 45 to 64 years (aHR = 1.193, p = 0.012). CONCLUSION Patients with cervical cancer undergoing radical hysterectomy have an increased risk of neurogenic bladder, which may result from nerve denervation caused by the operation. These patients should be informed of the potential risk of voiding dysfunction during discussion of the subsequent management for cervical cancer.
Collapse
Affiliation(s)
- Meng-Han Chou
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Guang-Huan Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| |
Collapse
|