Lymphoedema and nocturia/ nocturnal polyuria after pelvic lymph node dissection (LND) for urogenital cancer
Lymphoedema is the result of a dysfunction of the lymphatic system whether or not in combination with an extra load on the lymphatic system. Some patients develop lymphoedema after treatment of cancer. In this case, we speak of secondary or acquired lymphoedema. In Belgium, 11 645 patients were diagnosed with urogenital cancer in 2018. This includes prostate cancer and bladder cancer. A possible treatment option is prostatectomy or cystectomy in combination with a lymph node dissection. Patients receiving treatment for urogenital cancer, may develop lower limb lymphoedema (LLL), i.e. lymphoedema of the lower leg(s) or midline region. To our knowledge, incidence rate of lower limb lymphoedema is limited investigated and predisposing factors for its development is unknown. Further, no evidence exists regarding which (combination of) clinical measuring methods are most sensitive to detect early lymphoedema at the lower limbs after the treatment of cancer. In addition, the added value of manual lymph drainage, applied in patients with mild (early) lower limb lymphoedema and in addition to skin care, exercises and a compression stocking, has never been investigated.
Besides lower limb lymphoedema, the surgical treatment for urogenital cancer often results in urinary problems. In particular, urinary incontinence has been described in the literature. However, in clinical practice, it is clear that prostatectomy is often associated with other urinary complications, as nocturia and nocturnal polyuria. However, to our knowledge, trials investigating the point prevalence rate of nocturia and nocturnal polyuria after pelvic lymph node dissection for the treatment for urogenital cancer have never been performed. Furthermore, no trials investigated the predisposing factors for the development of nocturia/nocturnal polyuria after surgery for urogenital cancer.
Therefore, we will set up a prospective observational study, investigating the epidemiology, detection methods and early treatment of lower limb lymphoedema after pelvic lymph node dissection for urogenital cancer. Additionally, the epidemiology of nocturia and nocturnal polyuria will be studied as well.
150 subjects planned for pelvic lymph node dissection will be included and followed from baseline (before surgery) up to one year after the surgery. If a patient develops lower limb lymphoedema, he/ she has to wear a compression stocking and has to continue the usual care. In addition, she/ he is randomized into a group receiving MLD (intervention group) or not receiving MLD (control group).
> CarEdOn primary researchers: Prof. Nele Devoogdt, Prof. An De Groef, Dr. Tessa De Vrieze, Dra. Charlotte Van Calster
> Research partners: Prof. Inge Geraerts, Dpt of rehabilitation sciences, KU Leuven (Belgium); Prof. Wouter Everaerts. Dpt of urology, UZ Leuven (Belgium).
> Funding: n/a
> Keywords: Secondary edema, urogenital cancer, manual lymphatic drainage, edema