Evaluation of postoperative sexual, urinary and bowel function in women with early stage cervical cancer after nerve sparring radical trachelectomy versus vaginal radical trachelectomy

Sexual, micturation and defecation disorders are well known postoperative
complaints following radical hysterectomy in women with cervical cancer. Damage
to the autonomic innervation of bladder, rectum and vagina (the hypogastric
nerve and plexus) may be the leading cause of these disorders. Maas et al
showed significant damage to the autonomic nerves in conventional radical
hysterectomy at the cleavage site of the sacro-uterine ligament. Yabuki et al
were the first to perform a nerve sparring radical hysterectomy. This modified
radical hysterectomy appears to be safe in the sense of disease free survival.
Following nerve sparring surgery women have significantly less urinary
complaints and Pieterse showed that the vaginal response on sexual stimulation
(as an objective measure of function of the hypogastric nerve) is less impaired
after nerve sparring radical hysterectomy when compared to women after
conventional radical hysterectomy.


Radical trachelectomy can be used to treat women with early stage cervical
cancer who wish to preserve fertility because the uterine body is left in situ
while the uterine cervix with surrounding tissue as in radical hysterectomy
(including sacro-uterine ligament with the hypogastric nerve and plexus). This
surgical procedure can be performed vaginally or abdominally. In case of
abdominal trachelectomy the autonomic nerves can be saved as in nerve sparring
radical hysterectomy, while in vaginal trachelectomy it is not possible to
selectively save the autonomic nerves. Until now it is unclear if there is a
difference in sexual functioning and complaints concerning micturation and
defecation after abdominal versus vaginal trachelectomy. In theory abdominal
trachelectomy saves the autonomic nerves and this may result in less
complaints. On the other hand vaginal trachelectomy may not damage the
autonomic nerves because of different approach as compared to the abdominal
route, moreover vaginal trachelectomy results in less intraabdominal adhesions
and does not leave a large surgical scar on the abdomen with possible negative
effect on self-esteem en sexual functioning.

To compare sexual functioning and complaints concerning micturation and
defecation in women after abdominal or vaginal trachelectomy for early stage
cervical cancer.

The study is a questionnaire - study. Women who underwent abdominal or vaginal
trachelectomy will be asked to participate. Participating women are asked to
fill out three validated questionnaires: EORTC QLQ-C30 (cancer specific quality
of life questionnaire, EORTC QLQ-CX24 (cervical cancer specific quality of life
questionnaire and the Gynecologic Leiden Questionnaire (cervical cancer
specific questionnaire for sexual and pelvic floor symptoms). Copyright holding
authorities have approved the use of the questionnaires. The results of the
questionnaires will be compared according to surgical procedure.

No risk, minimal burden (3 questionnaires, approx 30 minutes) with possible
quality of life benefit for women who need to be treated for early stage
cervical cancer and wish to preserve fertility.