Urinary incontinence and quality of life in endometrial cancer patients after robotic-assisted laparoscopic hysterectomy with lymph node dissection

Abstract

To determine the long-term effects of lymph node dissection on lower urinary tract symptoms in patients treated for endometrial cancer. We conducted a retrospective cohort study of 74 patients with International Federation of Gynaecology and Obstetrics (FIGO) Stage I endometrial cancer who underwent surgical intervention with and without lymph node dissection, and evaluated them with the Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Patients who underwent lymph node dissection reported higher but not statistically different rates of bother by lower urinary tract symptoms compared to those without lymph node dissection. The scores for the lymph node dissection group and the control group were a mean IIQ-7 score of 14.9 ± 23 and 10.5 ± 22.9 (p=.419) and a mean UDI-6 score of 30.0 ± 25.3 and 20.7 ± 22.9 (p=.104), respectively. Lymph node dissection at the time of robotic-assisted surgery did not have a significant effect on lower urinary tract symptoms nor did it affect patient responses on quality of life questionnaires.IMPACT STATEMENTWhat is already known on this subject? The aetiology of urinary incontinence is multifactorial and there has been debate on how a patient’s surgical history affects their risk of developing urinary incontinence. Prior studies have highlighted the relationship between hysterectomy and urinary incontinence (Milsom et al. 1993 Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B. 1993. The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women. Journal of Urology 149:1459–1462.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Additional research has also been done to elucidate the prevalence of pelvic floor disorders in patients who have been surgically treated for endometrial cancer (Erekson et al. 2009 Erekson EA, Sung VW, DiSilvestro PA, Myers DL. 2009. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. International Urogynecology Journal and Pelvic Floor Dysfunction 20:159–163.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Nosti et al. 2012 Nosti PA, McDermott CD, Schilder JM, Stehman FB, Woodman PJ. 2012. Symptoms of pelvic floor disorders and quality of life measures in the postoperative patients with endometrial cancer. Clinical Ovarian and Other Gynecologic Cancer 5:27–30.[Crossref] , [Google Scholar]). There is limited information on how robotic-assisted lymphadenectomy during surgical staging for endometrial cancer affects patients’ urinary function and their quality of life.What do the results of this study add? In this manuscript, we demonstrate that patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH) with lymphadenectomy neither had significant difference in lower urinary tract symptoms nor on quality of life questionnaires as compared to those who did not undergo lymphadenectomy. Worsening of quality of life in regards to urinary incontinence should not be considered a factor of long term surgical morbidity associated with lymph node dissection.What are the implications of these findings for clinical practice and/or further research? There is a need for further studies that focus on the prevalence of pelvic floor disorders in patients after undergoing surgical staging for endometrial cancer and potential interventions that may address these issues.