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Abstract：
Bladder dysfunction is a common complication following radical hysterectomy, caused by the damage to pelvic autonomic nerves that innervate the muscles of the bladder, urethral sphincter, and pelvic floor fasciae. Bladder dysfunction increases the rates of urinary tract infection, hospital visits or admission, and patient dissatisfaction. In addition, bladder dysfunction can also negatively impact patient quality of life (QoL). Several postoperative interventions have been proposed to prevent bladder dysfunction following radical hysterectomy. To our knowledge, there has been no systematic review evaluating the effectiveness and safety of these interventions for preventing bladder dysfunction following radical hysterectomy in women with cervical cancer.
To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2).
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies.
We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer.
Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms.
We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms.
None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.
To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2).
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies.
We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer.
Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms.
We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms.
None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.
摘要：
膀胱功能障碍是根治性子宫切除术后常见的并发症，由支配膀胱肌肉的盆腔自主神经损伤引起，尿道括约肌,和盆底筋膜.膀胱功能障碍会增加尿路感染的发生率，医院就诊或入院，病人的不满。此外,膀胱功能障碍也会对患者的生活质量（QoL）产生负面影响。已经提出了几种术后干预措施来预防根治性子宫切除术后的膀胱功能障碍。据我们所知,目前尚无系统评价这些干预措施预防宫颈癌女性根治性子宫切除术后膀胱功能障碍的有效性和安全性.
评价早期宫颈癌（IA2至IIA2期）妇女行根治性子宫切除术后预防膀胱功能障碍的术后干预措施的有效性和安全性。
我们在Cochrane图书馆中搜索了Cochrane中央对照试验登记册（CENTRAL；2020，第4期），MEDLINEviaOvid(1946年至2020年4月第2周)，和EmbaseViaOvid（1980年至2020年，第16周）。我们还检查了临床试验的登记,灰色文学，会议报告,以及纳入研究的引文列表。
我们纳入了随机对照试验（RCTs），评估任何类型的术后干预措施在预防IA2至IIA2期宫颈癌女性根治性子宫切除术后膀胱功能障碍的有效性和安全性。
两位综述作者独立选择了潜在相关的RCT，提取的数据，评估的偏见风险，比较结果，并对证据的质量和确定性做出判断。我们通过与第三位评论作者的讨论或协商解决了任何分歧。感兴趣的结果包括手术后一周的自发排尿恢复，生活质量（QoL），不良事件,术后一个月排尿后残余尿量，术后一个月尿路感染,和主观的泌尿症状。
我们将1464条记录标识为搜索结果（不包括重复项）。在可能符合审查标准的20条记录中，我们纳入了4项研究的5份报告.大多数研究都不清楚选择和报告偏见的风险。在四项研究中，一项研究比较了苯甲酚和安慰剂,三项研究比较了耻骨上导管插入术和间歇性自我导管插入术.我们确定了两项正在进行的研究。Bethanechol与安慰剂的比较该研究没有报道手术后一周自发排尿恢复率的信息。QoL,不良事件,术后第一个月尿路感染,和主观泌尿症状进行比较。排尿后残余尿液的体积，手术后一个月评估，接受苯甲酚治疗的女性低于安慰剂组(平均差(MD)-37.4mL，95%置信区间(CI)-60.35至-14.45；一项研究，39名参与者；非常低的确定性证据)。耻骨上导管插入术与间歇性自我导管插入术的比较研究没有报告关于手术后一周的自发排尿恢复率和术后一个月的残余尿量的信息。急性并发症的风险没有差异（风险比（RR）0.77，95％CI0.24至2.49；一项研究，71名参与者；确定性证据非常低）和术后第一个月的尿路感染（RR0.77，95％CI0.53至1.13；两项研究，95名参与者；非常低的确定性证据）在接受耻骨上导管插入术的参与者和接受间歇性自我导管插入术的参与者之间。现有数据不足以计算干预措施对QoL和主观泌尿症状的影响的相对指标。
纳入的研究均未报道手术后一周的自发性排尿恢复率，尿后剩余尿量为50毫升或更少的时间，或术后6个月和12个月的残余尿量，所有这些都是评估术后膀胱功能障碍的重要结果.有限的证据表明，苯甲酚可以通过降低排尿后残余尿量来降低根治性子宫切除术后膀胱功能障碍的风险。这些证据的确定性,然而,非常低。不同类型的术后导尿（耻骨上和间歇性自我导尿）的有效性仍未得到证实。
评价早期宫颈癌（IA2至IIA2期）妇女行根治性子宫切除术后预防膀胱功能障碍的术后干预措施的有效性和安全性。
我们在Cochrane图书馆中搜索了Cochrane中央对照试验登记册（CENTRAL；2020，第4期），MEDLINEviaOvid(1946年至2020年4月第2周)，和EmbaseViaOvid（1980年至2020年，第16周）。我们还检查了临床试验的登记,灰色文学，会议报告,以及纳入研究的引文列表。
我们纳入了随机对照试验（RCTs），评估任何类型的术后干预措施在预防IA2至IIA2期宫颈癌女性根治性子宫切除术后膀胱功能障碍的有效性和安全性。
两位综述作者独立选择了潜在相关的RCT，提取的数据，评估的偏见风险，比较结果，并对证据的质量和确定性做出判断。我们通过与第三位评论作者的讨论或协商解决了任何分歧。感兴趣的结果包括手术后一周的自发排尿恢复，生活质量（QoL），不良事件,术后一个月排尿后残余尿量，术后一个月尿路感染,和主观的泌尿症状。
我们将1464条记录标识为搜索结果（不包括重复项）。在可能符合审查标准的20条记录中，我们纳入了4项研究的5份报告.大多数研究都不清楚选择和报告偏见的风险。在四项研究中，一项研究比较了苯甲酚和安慰剂,三项研究比较了耻骨上导管插入术和间歇性自我导管插入术.我们确定了两项正在进行的研究。Bethanechol与安慰剂的比较该研究没有报道手术后一周自发排尿恢复率的信息。QoL,不良事件,术后第一个月尿路感染,和主观泌尿症状进行比较。排尿后残余尿液的体积，手术后一个月评估，接受苯甲酚治疗的女性低于安慰剂组(平均差(MD)-37.4mL，95%置信区间(CI)-60.35至-14.45；一项研究，39名参与者；非常低的确定性证据)。耻骨上导管插入术与间歇性自我导管插入术的比较研究没有报告关于手术后一周的自发排尿恢复率和术后一个月的残余尿量的信息。急性并发症的风险没有差异（风险比（RR）0.77，95％CI0.24至2.49；一项研究，71名参与者；确定性证据非常低）和术后第一个月的尿路感染（RR0.77，95％CI0.53至1.13；两项研究，95名参与者；非常低的确定性证据）在接受耻骨上导管插入术的参与者和接受间歇性自我导管插入术的参与者之间。现有数据不足以计算干预措施对QoL和主观泌尿症状的影响的相对指标。
纳入的研究均未报道手术后一周的自发性排尿恢复率，尿后剩余尿量为50毫升或更少的时间，或术后6个月和12个月的残余尿量，所有这些都是评估术后膀胱功能障碍的重要结果.有限的证据表明，苯甲酚可以通过降低排尿后残余尿量来降低根治性子宫切除术后膀胱功能障碍的风险。这些证据的确定性,然而,非常低。不同类型的术后导尿（耻骨上和间歇性自我导尿）的有效性仍未得到证实。
