Modalities of pelvic autonomic nerve-sparing surgery in pelvis-gynecology / 中国癌症杂志

ABSTRACT

Bladder function is controlled by the hypogastric nerves (sympathetic) and pelvic splanchnic nerves (parasympathetic) , and these two nerve fibers intermingle to form the pelvic plexus. Pelvic surgery was one of the important modalities being used in pelvis-gynecology, but it was commonly found that the modality could cause bladder dysfunction because of its damage to the pelvic plexus. Pelvis-gynecologic surgeries like Pive Ⅱ-Ⅳ radical hysterectomy (RH), total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration are among the most important causes of urinary dysfunction. Recently, urinary dysfunction has become the major issue for patients undergoing pelvic surgery in terms of quality-of-life. Pelvic autonomic nerve-sparing (PANS) protects postsurgical bladder function in radical RH and other pelvic surgery. The review tried to discuss different types of PANS being used in variety of pelvis-gynecologic surgery. Type Ⅰ PANS can be performed in Piver Ⅱ RH in patients with endometrioid cancer, and urinary catheter will be removed 3 days after operation. Type Ⅱ PANS is used in Piver Ⅲ RH, and the catheter can be successfully removed 7 days after surgery. Sometimes, type Ⅲ PANS is administered in one-side tumor-free cardinal ligament resection, and the patients will retain their catheter for 3 weeks postoperatively. Type Ⅱ or type Ⅲ PANS may be used in total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration.