Urinary Satisfaction of Patients Who Underwent Robot-Assisted Nerve-Sparing Radical Hysterectomy

Yoshihito Yokoyama, Atsushi Fukui, Rie Fukuhara, Tatsuhiko Shigeto, Masayuki Futagami, Tsuyoshi Higuchi, Hideki Mizunuma


The purpose of this study was to understand the actual situation of urination impairment to understand whether a robot-assisted nerve-sparing radical hysterectomy (RA-NSRH) is superior to an open radical hysterectomy (RH) in point of nerve sparing. The outcomes of the operation and urination were compared between patients who had undergone an open NSRH (n = 7) in the same period as RA-NSRH (n = 7) and patients who had undergone RH without the consideration of nerve sparing (n = 20). In addition, a questionnaire survey was conducted concerning urination, including presence or absence of a desire to urinate, urinary straining, and urinary incontinence, as well as a urinary satisfaction, in 36 patients who had undergone a robot-assisted hysterectomy, including seven patients who had undergone RA-NSRH and 22 patients who had undergone an open RH without intermittent self catheterization. Although the surgical time of RA-NSRH was significantly longer than that of open RH, the amount of bleeding was significantly less and the days of hospitalization were significantly fewer in RA-NSRH. The completion rates of both the surgeries were similar from the viewpoint of the number of pelvic lymph nodes removed. The period to complete spontaneous urination was significantly shorter in the RA-NSRH group than that in the open NSRH and normal RH groups. There was no difference in the post-operative urinary satisfactions of patients between the RA-NSRH (75.0 points) and open RH groups (including NSRH) (71.1 points) if the pre-operative urinary condition was defined as 100. Ganglion cells were found in the posterior layer part of vesicouterine ligament of patients in the RA-NSRH group and an autonomic nerve was partly spared. RA-NSRH could not improve a long-term urinary satisfaction. Therefore, more improvement of the operative method will be required to enhance the quality of life (QOL).

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