# Postvoid Residual Volume After Radical Hysterectomy for Early-Stage Cervical Cancer: Predictive Factors and a Decision-Making Algorithm

## TL;DR

This study identifies factors affecting bladder function recovery after cervical cancer surgery and proposes a management algorithm based on postvoid residual volume.

## Contribution

The study introduces a risk-adapted decision-making algorithm for postoperative voiding management based on postvoid residual volume thresholds.

## Key findings

- Type C1 radical hysterectomy is associated with a significantly higher risk of postoperative bladder dysfunction compared to B1 surgery.
- A postvoid residual volume threshold of ≥170 mL on postoperative day 1 identifies C1 patients at high risk for delayed recovery.
- B1 surgery patients can safely have catheters removed on day 1, while C1 patients require a voiding trial.

## Abstract

This retrospective study examined the normalization of bladder function after radical hysterectomy, identifying the predictive factors linked to postoperative bladder dysfunction and defining a postvoid residual volume threshold that could guide postoperative voiding management. A total of 67 patients with early-stage cervical cancer who underwent either type B1 or type C1 radical hysterectomy were recruited. By postoperative day 3, 73.1% of patients had recovered normal voiding. Recovery was faster after B1 surgery than after C1 surgery, with a median recovery of 1 day and 2.5 days, respectively. Type C1 radical hysterectomy was associated with a significantly higher risk of postoperative bladder dysfunction. At discharge, 19.4% of patients still required catheterization. Based on these findings, a risk-adapted management algorithm was proposed: catheters can be safely removed on day 1 after B1 surgery, while C1 patients should undergo a voiding trial, with delayed catheter removal if postvoid residual volume is ≥170 mL.

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.