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Li et al. World Journal of Surgical Oncology (2019) 17:141 https://doi.org/10.1186/s12957-019-1689-2 RESEARCH Open Access Curative efficacy of low frequency electrical stimulation in preventing urinary retention after cervical cancer operation Huan Li1,2†, Can-Kun Zhou4†, Jing Song1,2, Wei-Ying Zhang1,2, Su-Mei Wang1,2, Yi-Ling Gu1,2, Kang Wang1,2, Zhe Ma1,2, Yan Hu1,2, Ai-Min Xiao1,2, Jian-Liu Wang3 and Rui-Fang Wu1,2* Abstract Background: To evaluate the clinical significance of low-frequency electrical stimulation in preventing urinary retention after radical hysterectomy. Methods: A total of 91 women with stage IA2–IB2 cervical cancer, who were treated with radical hysterectomy and lymphadenectomy from January 2009 to December 2012, were enrolled into this study and were randomly divided into two groups: trail group (48 cases) and control group (43 cases). Traditional bladder function training and low- frequency electrical stimulation were conducted in the trail group, while patients in the control group were only treated by traditional bladder training. The general condition, rate of urinary retention, and muscle strength grades of pelvic floor muscle in the perioperative period were compared between these two groups. Results: The incidence of postoperative urinary retention in the electrical stimulation group was 10.41%, significantly lower than that in the control group (44.18%), and the difference was statistically significant (P < 0.01). The duration of postoperative fever and use of antibiotics were almost the same between these two groups. Eleven days after surgery, the difference in grades of the pelvic floor muscle between these two groups was not statistically significant. However, 14 days after the operation, grades of the pelvic floor muscle were significantly higher in the trail group than in the control group, and the difference was statistically significant (P < 0.01). In addition, although there was no significant difference between the two groups with different parameters (P = 0.782), the incidence of urinary retention was lower in the endorphins analgesia program group than in the neuromuscular repair program group (9.09% < 11.54%). Conclusion: Low-frequency electrical stimulation is more effective than conventional intervention in preventing urinary retention after radical hysterectomy. It also intensifies the recovery of pelvic muscle strength. Keywords: Cervical cancer, Urinary retention, Low-frequency electrical stimulation, Bladder training, Pelvic muscle strength Introduction Cervical cancer is the most common gynecologic malig- nant tumor, and extensive panhysterectomy is a radical surgery for the treatment of cervical cancer. The wide range of surgical resections (including the uterus, fallo- pian tube, the upper part of the vagina, the main ligament, and the paracolpium) and the complete dissec- * Correspondence: [email protected] †Huan Li and Can-Kun Zhou contributed equally this work. tion of the pelvic lymph nodes often brings a number of 1Shenzhen Early Diagnosis of Gynecological Major Disease Laboratory, postoperative complications such as bladder dysfunction Department of Gynecology, Peking University Shenzhen Hospital, Shenzhen (anesthesia, urinary incontinence, and urinary retention), 518035, Guangdong, China 2Shenzhen Technical Research and Development Center on Gynecologic lymph cyst, lymphedema, ureterovaginal fistula, intes- Oncology, Shenzhen 518035, Guangdong, China tinal obstruction, wound infection, and urinary tract Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Li et al. World Journal of Surgical Oncology (2019) 17:141 Page 2 of 7 infections, in which bladder dysfunction is the most distant metastasis, and (4) the patient agreed to con- common [1]. The incidence of bladder dysfunctions duct the study and sign an informed consent form. after radical hysterectomy for cervical cancer is 8.0– The exclusion criteria are as follows: (1) patients with 80% [2, 3]. Postoperative urinary retention can lead intraoperative urinary tract injury (except ureteral in- to the excessive expansion of the bladder or even jury), (2) preoperative diagnosis of moderate or above permanent detrusor damage, and preventing urinary stress urinary incontinence (diaper pad test a 10 g), (3) retention through an indwelling catheter may bring preoperative urinary retention, and (4) those with un- pain and inconvenience to the patient, increasing the controlled epilepsy, central nervous system diseases, incidence of urinary tract infection [4, 5]. In recent mental disorders, or with pacemakers. years, some scholars have begun to apply electrical stimulation for postoperative rehabilitation of malig- nant tumors, effectively improving the quality of life Therapeutic methods of patients. Mariotti et al. randomly divided 60 pa- Patients in the two groups underwent bladder func- tients with prostate cancer into two groups accord- tion training [8]. Specific operations were as follows. ing to 1:1. The treatment group received pelvic floor From the 11th day after surgery, between 8 a.m. and electrical stimulation on the seventh day after the 10 p.m., the catheter was opened every 2 h for 15 min operation, and the control group received routine each time, while the catheter was fully opened from nursing treatment. Postoperative follow-up showed 10 p.m. to 8 a.m. the next day, until the catheter was that the urination function of the treatment group pulled out. From the 11th day since the operation, was significantly better than that of the control patients in the trial group were given electrical stimu- group [6]. In terms of gynecologic malignancies, Eun lation treatment and bladder function training for et al. randomized 34 patients with gynecologic ma- 3 days using the Phenix VBS neuromuscular stimula- lignancies to two groups; the electrical stimulation tion therapy system (France) [9]; the system is based group received 4 weeks of electrical stimulation, and on the Glazer Protocol, which was originally proposed the control group received conventional treatment. in 1997 to provide not only a fixed sequence of The quality of life questionnaire showed that the muscle action and its measurements, but also a data- quality of life and pelvic floor function of the pa- base of sEMG readings for normal subjects and pelvic tients in the electrical stimulation group were signifi- floor dysfunction patients. In the electrical stimulation cantly better than those in the control group [7]. At treatment group, the patient was placed in a supine present, there are few studies on the rehabilitation position, one piece of the electrode was placed in the treatment of urinary retention electrical stimulation bladder area under the symphysis pubis, and the after cervical cancer surgery. Based on the previous other piece was placed on the bone. Two sets of dif- studies, we will fill in the gaps in related research ferent parameters were chosen according to different fields and provide effective treatment methods for treatment principles: electrical stimulation frequency improving the postoperative quality of life of patients was 35 Hz and pulse width was 200 μs (neuromuscu- with cervical cancer. lar repair program, group A) or frequency was 1 Hz and pulse width was 270 μs (endorphins analgesia Methods program, group B), for 15 to 30 min each time, twice General information a day for 3 days. Patients in the control group only A total of 91 patients with stage IA2–IB2 cervical received bladder function training for 3 days. cancer, who underwent extensive panhysterectomy The catheters were removed from all patients in the and pelvic lymph node dissection in our department two groups at 14 days after the surgery. On the same from January 2009 to December 2012, were enrolled day, residual urine volumes in bladders were measured intothestudyandwererandomlydividedintotwo by B ultrasound to observe whether urinary retention groups through the closed-envelop method by a per- occurred. At the same time, pelvic floor muscle strength son who did not participate in the study: electrical was also determined. stimulation treatment group (trial group) and control Bladder residual urine volume refers to the amount of group. There were 48 patients in the trial group and urine saved in the bladder after urination. This is one of 43 patients in the control group. The researchers who the important indicators for determining bladder urin- collected the data were unaware of the assignment of ation function: participants. The inclusion criteria are as follows: (1) Urinary retention is when the patient cannot urinate age 18–60 years old, (2) type III hysterectomy for cer- smoothly, bladder residual urine volume was ≥ 100 ml as vical cancer, (3) postoperative pathology indicated determined by B ultrasound, or cannot self-discharge that the cancer was completely removed and without and need to reset the catheter. Li et al. World
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