The most disturbing thing after radical cervical cancer surgery is urinary disorder, such as loss of desire to urinate or difficulty in urination, and even if they can urinate, there will be a considerable amount of residual urine. Some patients are unable to urinate on their own for several weeks after surgery, but do not be alarmed, as they should be trained under the guidance of their primary care physician and will gradually regain their self-voiding function. This is mainly due to the extensive surgery required for treatment, which inevitably damages the sympathetic and parasympathetic nerves that innervate the bladder and urethra bilaterally. It is also associated with the loss of bladder neck support by hysterectomy and bladder hyperextension. The type and severity of bladder dysfunction is related to the extent and thoroughness of surgery for cervical cancer, i.e., the more extensive and thorough the surgery, the more likely it is to result in postoperative difficulty in voluntary urination, and also to the preoperative bladder function status.
The necessity of retaining urinary catheter after cervical cancer surgery
1.The nature and volume of urine can be observed at any time to provide a basis for treatment.
2.To avoid bladder distension which affects the recovery of its function.
Prevention of infection
1.Choose suitable catheter.
Use double-lumen balloon catheter, conduct urinary catheterization under strict aseptic operation in all aspects, and keep the catheter draining smoothly, prevent pressure and distortion, change the urine bag regularly, and operate strictly aseptically.
2.Drinking more water should be encouraged, more than 2L of water should be drunk every day, and urination should be done at least once every 3h.
3.Care of urinary catheter and perineum.
Keep the urethral orifice and perineum and external genitalia clean, scrub the perineum with warm water, rinse with 0.9% saline daily, keep the local skin clean and dry, empty the urine in the urine storage bag in time, keep the drainage bag drainage lower than the bladder to prevent urine reflux. Keep urine drainage unobstructed.
Bladder function exercise
1.Intermittent clamping of the urinary catheter.
1 week after surgery, intermittent urine release can be used, once every 2 to 4 hours, which is conducive to the recovery of bladder autoregulation. However, it should be noted that the time of intermittent clamping of the ureter is judged by the estimated amount of urine, and it is appropriate to release about 300ml each time, and the opening interval should be shortened if there is much water.
2, in each open urinary catheter can go to the toilet to increase abdominal pressure to assist urine discharge
Removal of urinary catheter
1.Increase abdominal pressure to assist urination after removal of urinary catheter
The patient takes a sitting position, leans forward, and presses the lower abdomen on the pubic bone with his hand when urinating, and then uses the breath-holding method to contract the abdominal muscle to make urine discharge.
When applying the breath-holding method, the abdomen is relaxed and then the abdominal muscles are contracted, and the patient is trained to contract the abdominal muscles with force in the direction of abdominal pressure toward the bladder and pelvic floor, thus increasing the pressure on the bladder and pelvic floor and prompting urine discharge.
2.There are two methods to measure the amount of residual urine
One is to insert a catheter after the patient has voided urine and measure the residual urine; the other is to measure the volume of the bladder by ultrasound, so as to calculate the residual urine volume. If the residual urine is >100ml continue to keep the catheter for 1 week. But be sure to measure immediately after urination!
3.Sitz bath (can be tried)
Immediately after removal of the urinary catheter, take a sitz bath with 1:5,000 furacilin solution at a temperature of 38-43°C once every 2 hours for 10-20 min, and encourage the patient to urinate on his own after the sitz bath.
Hot water bath can be used to stimulate the nerve receptors around the urethra by using the heat of water can promote urination.
4.Other
Combine with acupuncture, physical therapy, vitamin B acupuncture point injection (foot Sanli, Sanyinjiao, Guan Yuan, etc.), induction electrotherapy, acupoint stimulation low frequency therapy, ultra-short wave therapy and hot air bath therapy, etc.
Patients can listen to the sound of running water, also hot massage bladder and exercise abdominal whistling, anal lifting training, enhance the contraction ability of the urethral sphincter, if necessary, intramuscular injection neostigmine 10 ~ 20mg.