Urinary retention is a common complication after extensive hysterectomy, with an incidence of 7.5% to 44.9%, and is defined as the inability to urinate on one’s own for more than 15 days after surgery or the ability to urinate on one’s own but with a residual urine volume of ≥100 ml. As extensive total hysterectomy inevitably damages intrapelvic blood flow and parasympathetic nerves, resulting in different degrees of bladder forced urinary muscle dysfunction; at the same time, extensive bladder dissection during surgery causes damage to bladder wall ganglia and blood supply, and changes in bladder position, all of which are causes of urinary retention.
Urinary retention can easily lead to secondary urinary tract infections, and those with chronic infections can have acute attacks. Urinary tract infections are divided into lower urinary tract infections and upper urinary tract infections, both of which can spread to each other or exist simultaneously. Lower urinary tract infections are mainly cystitis, peri-cystitis and urethritis. Upper urinary tract infections are mainly nephronephritis, which may develop into renal swelling and perinephric abscess in severe cases, most commonly cystitis and pyelonephritis.
Treatment of urinary tract infection: Patients in the acute stage should rest in bed, drink more water to increase the volume of urine, strengthen the flushing effect of urine, and promote the discharge of bacteria. At the same time, the body’s resistance to disease should be enhanced, and the primary cause should be actively treated to eliminate the cause of the disease. Appropriate antibiotics should be selected according to urine culture and drug sensitivity results. In cases of severe infection, antibiotics should be applied in combination and should be given again if recurrence occurs.
Prevention of urinary tract infection:
1.Preoperative treatment of urethral and vaginal inflammation and other local infections.
2. Strictly aseptic operation should be carried out when placing the urinary catheter, with gentle movements to avoid damaging the urethral mucosa. For closed catheter placement, the catheter and urine bottle should be changed daily.
3. Encourage the patient to drink water several times, keep the urethra open and the vulva clean, and scrub the vulva twice a day until the urethra is removed. The bladder can be flushed with 0.2% furacilin solution during the period of indwelling urinary catheter.
4. If urinary retention and difficulty in urination occur, active treatment should be given until bladder function is restored.
It is reported in the literature that simultaneous bladder suspension during extensive hysterectomy for cervical cancer and endometrial cancer can well reduce the incidence of postoperative urinary retention and achieve better clinical results.
The main theoretical basis is.
①The nerves innervating the bladder mainly come from sacral nerve segments 2 to 4, and the bladder plexus is located in the paravaginal and parametrial tissues. Urinary tract dysfunction under extensive hysterectomy is mainly caused by injury to the pelvic plexus and pelvic nerves, and the larger the scope of surgery, the more vaginal and paravaginal tissues are removed, the higher the incidence of postoperative urinary tract dysfunction;
(ii) Urinary retention is also associated with loss of support to the bladder neck after hysterectomy resulting in bladder hyperextension. The change in the position of the bladder after hysterectomy is also the key to postoperative urinary retention, as the cervical ligament of the bladder starts behind the pubic symphysis and extends towards the base of the bladder ending in the anterior wall of the cervix, which gives strong support to the bladder from the base.
Simultaneous bladder suspension during extensive hysterectomy.
Step 1: First, the top of the bladder is suspended and fixed for a little while to restore only a small part of the normal anatomical position of the bladder, but its two corners may still collapse and it is more difficult to restore urinary function in a short period of time by relying only on bladder smooth muscle contraction in the absence of bladder nerves;
The second step: relative fixation of both sides of the bladder again, forming a situation similar to that of the bladder before hysterectomy where the two corners of the bladder are relatively fixed by the cervical ligament of the bladder, so that the original anatomical structure of the bladder is further partially restored and its function is limited by avoiding bladder collapse after surgery, which maintains both the normal anatomical position of the bladder and the normal anatomical angle of the bladder neck.
Therefore, simultaneous bladder suspension during extensive hysterectomy in patients with cervical cancer (stage IB-IIA) can theoretically restore the normal anatomical position of the bladder and the anatomical angle of the bladder neck for the most part. It is beneficial to reduce the incidence of postoperative urinary retention.
Urinary retention is defined as the inability to urinate on one’s own for more than 15 days after surgery or the ability to urinate on one’s own but with a residual urine volume of ≥100 ml. Urinary retention is one of the common complications after extensive hysterectomy, with an incidence of 7.5% to 44.9%. As extensive total hysterectomy inevitably damages intrapelvic blood flow and parasympathetic nerves, resulting in different degrees of bladder forced urinary muscle dysfunction; at the same time, extensive bladder dissection during surgery causes damage to bladder wall ganglia and blood supply, and changes in bladder position, all of which are causes of urinary retention.
Urinary retention can easily lead to secondary urinary tract infections, and those with chronic infections can have acute attacks. Urinary tract infections are divided into lower urinary tract infections and upper urinary tract infections, both of which can spread to each other or exist simultaneously. Lower urinary tract infections are mainly cystitis, peri-cystitis and urethritis. Upper urinary tract infections are mainly nephronephritis, which may develop into renal swelling and perinephric abscess in severe cases, most commonly cystitis and pyelonephritis.
Treatment of urinary tract infection: Patients in the acute stage should rest in bed, drink more water to increase the volume of urine, strengthen the flushing effect of urine, and promote the discharge of bacteria. At the same time, the body’s resistance to disease should be enhanced, and the primary cause should be actively treated to eliminate the cause of the disease. Appropriate antibiotics should be selected according to urine culture and drug sensitivity results. In cases of severe infection, antibiotics should be applied in combination and should be given again if recurrence occurs.
Prevention of urinary tract infection:
1.Preoperative treatment of urethral and vaginal inflammation and other local infections.
2. Strictly aseptic operation should be carried out when placing the urinary catheter, with gentle movements to avoid damaging the urethral mucosa. For closed catheter placement, the catheter and urine bottle should be changed daily.
3. Encourage the patient to drink water several times, keep the urethra open and the vulva clean, and scrub the vulva twice a day until the urethra is removed. The bladder can be flushed with 0.2% furacilin solution during the period of indwelling urinary catheter.
4. If urinary retention and difficulty in urination occur, active treatment should be given until bladder function is restored.
It is reported in the literature that simultaneous bladder suspension during extensive hysterectomy for cervical cancer and endometrial cancer can well reduce the incidence of postoperative urinary retention and achieve better clinical results.
The main theoretical basis is.
①The nerves innervating the bladder mainly come from sacral nerve segments 2 to 4, and the bladder plexus is located in the paravaginal and parametrial tissues. Urinary tract dysfunction under extensive hysterectomy is mainly caused by injury to the pelvic plexus and pelvic nerves, and the larger the scope of surgery, the more vaginal and paravaginal tissues are removed, the higher the incidence of postoperative urinary tract dysfunction;
(ii) Urinary retention is also associated with loss of support to the bladder neck after hysterectomy resulting in bladder hyperextension. The change in the position of the bladder after hysterectomy is also the key to postoperative urinary retention, as the cervical ligament of the bladder starts behind the pubic symphysis and extends towards the base of the bladder ending in the anterior wall of the cervix, which gives strong support to the bladder from the base.
Simultaneous bladder suspension during extensive hysterectomy.
Step 1: First, the top of the bladder is suspended and fixed for a little while to restore only a small part of the normal anatomical position of the bladder, but its two corners may still collapse and it is more difficult to restore urinary function in a short period of time by relying only on bladder smooth muscle contraction in the absence of bladder nerves;
The second step: relative fixation of both sides of the bladder again, forming a situation similar to that of the bladder before hysterectomy where the two corners of the bladder are relatively fixed by the cervical ligament of the bladder, so that the original anatomical structure of the bladder is further partially restored and its function is limited by avoiding bladder collapse after surgery, which maintains both the normal anatomical position of the bladder and the normal anatomical angle of the bladder neck.
Therefore, simultaneous bladder suspension during extensive hysterectomy in patients with cervical cancer (stage IB-IIA) can theoretically restore the normal anatomical position of the bladder and the anatomical angle of the bladder neck for the most part. It is conducive to reducing the incidence of postoperative urinary retention.