Introduction. Type D radical hysterectomy for locally advanced cervical cancer is traditionally associated with a high risk of injury to the pelvic autonomic nerve structures and the development of significant bladder dysfunction. The application of nerve-sparing techniques in such an extensive surgical procedure remains technically challenging. To date, there are no published reports in the literature describing nerve-sparing type D radical hysterectomy.
Clinical case. A clinical case of a patient with stage IIB cervical cancer is presented. Patient received two cycles of super-selective intra-arterial neoadjuvant chemotherapy consisting of intra-arterial cisplatin (75 mg/m²) and intravenous paclitaxel (175 mg/m²), followed by nerve-sparing type D radical hysterectomy. A marked tumor regression after neoadjuvant treatment enabled precise identification of the pelvic autonomic nerve structures and their preservation within oncologically acceptable margins.
Conclusion. In the postoperative period, early recovery of spontaneous voiding was observed, indicating functional integrity of the preserved nerve structures. This case demonstrates the feasibility of successfully applying nerve-sparing techniques during type D radical hysterectomy after intra-arterial neoadjuvant chemotherapy and highlights the importance of urodynamic assessment as objective criteria of urination functional safety.
