Lymphaticovenular Anastomosis as a Treatment for Neurogenic Bladder in Patients With Lower Extremity Lymphedema After Gynecologic Cancer Treatment.

Abstract

Background and objectives: Neurogenic bladder (NB), a complication of gynecological cancer treatment, entails significant symptoms such as loss of urinary urgency, incontinence, and renal dysfunction. To investigate whether lymphatic fluid stagnation at the pelvis causes NB, we investigated the effectiveness of lymphaticovenular anastomosis (LVA) for NB.

Methods: In this retrospective study between 2014 and April 2024, LVA was performed on 52 patients complaining of preoperative urinary dysfunction with lower extremity lymphedema following pelvic lymphadenectomy in gynecologic cancer treatment. Pre- and postoperative assessments evaluated NB symptoms and volume reduction of lower extremities.

Results: With an average follow-up period of 35.0 months, the volume of the affected limbs was reduced in all patients. Symptoms of urinary function were improved in 44 out of 52 patients, as improved urinary urgency, disappearance of incontinence, and independence from self-catheterization. Among 15 patients who underwent pre- and postoperative questionnaire assessment of NB, the mean score of NB severity decreased significantly from 16.9 ± 7.1 points preoperatively to 4.3 ± 3.6 points postoperatively (p < 0.01).

Conclusions: The specific reason for NB following gynecologic cancer treatment remains unclear. Our study results suggest that lymphatic fluid stagnation itself might be a reason for NB and LVA could reduce these symptoms.