Abstract
To assess changes of menstrual patterns, their causes, preventions and treatment methods after abdominal radical trachelectomy (ART), we recorded patients’ menstrual patterns after surgery and compared them with the conditions before surgery. Patients were divided into 3 groups based on their menstrual status post-trachelectomy:Group 1: menstrual patterns unchanged; Group 2: menstrual patterns changed without amenorrhea; and Group 3: amenorrhea. One hundred and twenty-nine patients were included: 39 (30.2%) women belonged to Group 1, 74 (57.4%) to Group 2 and 16 (12.4%) to Group 3. For patients in Group 2, the most common presenting symptom was decrease of menstrual volume (59, 79.7%), followed by a prolonged (33, 44.6%) menstrual bleeding. All of the changes in Group 2 and 12 cases in Group 3 were due to narrow of the remaining cervical os. Additionally, 9 and 12 patients, respectively, in Group 2 and 3, developed cervical stenosis. To maintain regular menstruation and prevent isthmic stenosis, 99 patients had tailed intrauterine devices (IUDs) placed in the uterine cavity. Incidence of cervical stenosis all happened in patients without IUDs placed in the uterine cavity. Menstrual condition improved in all patients except one after dilation of the new-cervix. Our results demonstrated that the majority of patients suffered from changes in menstrual patterns after ART. Narrowing of the remaining cervical canal was the main reason and could be treated by cervical dilation. The use of a tailed IUD was effective in the prevention of this complication.
Highlights
Radical trachelectomy (RT) in combination with pelvic lymph node dissection is regarded as an alternative to radical hysterectomy and is increasingly being offered to selected women with early stage cervical carcinoma who wish to preserve fertility
Patients were divided into 3 groups based on their menstrual status post-trachelectomy:Group 1: menstrual patterns unchanged; Group 2: menstrual patterns changed without amenorrhea; and Group 3: amenorrhea
Our results demonstrated that the majority of patients suffered from changes in menstrual patterns after abdominal radical trachelectomy (ART)
Summary
Radical trachelectomy (RT) in combination with pelvic lymph node dissection is regarded as an alternative to radical hysterectomy and is increasingly being offered to selected women with early stage cervical carcinoma who wish to preserve fertility. Changes in menstrual patterns, which are unique postoperative manifestations that might impact patients’ quality of life and obstetrical outcomes following radical trachelectomy, have not been thoroughly investigated. No study has investigated the incidences, risk factors, prevention and treatment methods of such a complication. Because amenorrhea is associated with infertility, and changes of menstruation can increases the risk of anxiety and discomfort, better understanding of the menstrual changes after RT would facilitate patients counseling about fertility options and help improve patients’ quality of life
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