Objective: Our study evaluated the time to normalization of postvoid residual volume after radical hysterectomy and identified risk factors for postoperative bladder dysfunction. We also aimed to establish a predictive threshold for bladder dysfunction on the third postoperative day to develop a decision-making algorithm for postoperative voiding management. Methods: This retrospective, single-center study included early-stage cervical cancer patients undergoing type B1 or C1 radical hysterectomy. Factors associated with elevated postvoid residual volume were analyzed using logistic regression, and the threshold was determined using the Youden index. Results: 67 patients were included: 36 patients (53.7%) underwent C1 radical hysterectomy and 31 (46.3%) B1. At discharge, 13 (19.4%) patients required a catheter: 8 (61.5%) required intermittent catheterization, 5 (38.5%) had a Foley catheter. By postoperative day 3, 49 (73.1%) patients recovered their voiding function. The median time to postvoid residual volume recovery was 1 day (IQR: 1–2) for type B1 and 2.5 days (IQR: 2–5) for type C1 (p< 0.01). Compared with B1, C1 radicality was independently associated with a higher risk of postoperative voiding dysfunction (OR = 11.46; 95% CI: 1.75–75.24;p< 0.05). Based on these findings, we propose an algorithm for risk-adapted postoperative voiding management: B1 patients can safely have catheters removed on postoperative day 1 without a voiding trial, whereas C1 patients require one. C1 patients with postvoid residual volume ≥170 mL should have delayed catheter removal. Conclusions: Surgical radicality is a risk factor for postoperative bladder dysfunction. In type C1 radical hysterectomy, a postvoid residual volume ≥170 mL on the first postoperative day identifies patients at high risk of delayed recovery, supporting a tailored approach to postoperative voiding management.
目的：本研究旨在评估根治性子宫切除术后排尿后残余尿量恢复正常所需的时间，并识别术后膀胱功能障碍的风险因素。同时，我们试图建立术后第三天膀胱功能障碍的预测阈值，以制定术后排尿管理的决策算法。方法：这项回顾性单中心研究纳入了接受B1型或C1型根治性子宫切除术的早期宫颈癌患者。采用逻辑回归分析与排尿后残余尿量升高相关的因素，并通过约登指数确定阈值。结果：共纳入67例患者，其中36例（53.7%）接受C1型根治性子宫切除术，31例（46.3%）接受B1型。出院时，13例（19.4%）患者需要导尿管：8例（61.5%）需间歇性导尿，5例（38.5%）留置Foley导尿管。至术后第三天，49例（73.1%）患者排尿功能恢复。B1型患者排尿后残余尿量恢复的中位时间为1天（四分位距：1-2），C1型为2.5天（四分位距：2-5）（p<0.01）。与B1型相比，C1型根治术与术后排尿功能障碍风险升高独立相关（比值比=11.46；95%置信区间：1.75-75.24；p<0.05）。基于这些发现，我们提出一种基于风险的术后排尿管理算法：B1型患者可在术后第一天安全拔除导尿管而无需排尿试验，而C1型患者则需进行试验。对于C1型患者，若排尿后残余尿量≥170 mL，应延迟拔除导尿管。结论：手术根治程度是术后膀胱功能障碍的风险因素。在C1型根治性子宫切除术中，术后第一天排尿后残余尿量≥170 mL可识别出延迟恢复高风险患者，这支持了术后排尿管理的个体化策略。
肿瘤(癌症)患者之家