The importance of monitoring neurological manifestations in rehabilitation after radical hysterectomy

E. Begovich, S. V. Demyanov, G. V. Demyanov
In: Journal of Medical Rehabilitation · 2024 · vol. 2(1) , pp. 122–132 · doi:10.17749/2949-5873/rehabil.2024.20 · W4402371544
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Abstract

Background. Hysterectomy is currently one of the most frequently performed surgical operations in obstetrics and gynecology, second only to cesarean section. However, such intervention is often associated with the risk of complications, including neurological ones. Neurological consequences, due to their characteristics, go beyond physical manifestations and exert psycho-emotional pressure on patients. Objective: to determine the need for monitoring neurological manifestations in women undergoing rehabilitation after hysterectomy. Material and methods. The search and selection of studies in Russian and English languages were conducted according to PRISMA recommendations in scientific databases and electronic libraries: PubMed/MEDLINE, ScienceDirect, Google Scholar, Microsoft Academic, DOAJ, eLibrary, CiberLeninka. In total, 2569 publications were revealed; after subsequent screening 57 articles were selected, which were devoted to the study of neurological adverse effects of hysterectomy and met all the screening criteria. Results. Among all the neurological complications mentioned, the most common is chronic postoperative pain. It is detected in 30% of cases. At the same time, in the vast majority of cases, such pains are rare and are tolerated as mild discomfort. However, there is no unambiguous understanding of the nature of this complication. There is a theory about the essential role of estrogen production and substance P ratio in pain manifestations. Thus, a decrease in estrogen production with unchanged synthesis of substance P significantly reduces the pain threshold in patients, which is the cause of the observed chronic pain. A certain contribution to the formation of this neurological complication is made by residual ovarian syndrome, which is associated with incomplete removal of the ovaries during ovariectomy, traumatic neuroma and mononervopathy. Damage to the nerves or their plexuses in the pelvic area can cause intestinal and urinary disorders, leading to a decrease in the quality of life of patients. Excessive anxiety and depression are additional risk factors for the development of chronic pain after hysterectomy, and the accompanying postoperative changes often have a physical manifestation, for example, in the form of insomnia, restless legs syndrome and sexual dysfunction. Conclusion. Hysterectomy is certainly an effective way to treat a number of gynecological diseases, but it often causes complications that require correction of the rehabilitation program. Neurological negative manifestations need special monitoring, since the depressive state of patients may lead to chronicity of pathological processes.

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