[Voiding dysfunction after surgical resection of deeply infiltrating endometriosis: pathophysiology and management]
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Nerve damage during endometriosis resection causes bladder dysfunction, with rates up to 30% after uterosacral ligament resection, managed by self-catheterization or neuromodulation in refractory cases.
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Abstract
Autonomic nerve (sympathic and parasympathic) damage plays a crucial role in the aetiology of bladder dysfunction that occurs after resection of deeply infiltrating endometriosis (uterosacral ligaments, colorectal bowel, rectovaginal wall). This review presents an overview of the pathophysiology and management of voiding dysfunction that occur after this kind of surgery. The rate of significant post-voiding residual volume and/or hypoactive bladder after colorectal resection for endometriosis ranges from 15 to 20%. This rate seems to be higher (up to 30%) after proximal utero-sacral ligaments resection. This is explained by the location of the inferior hypogastric plexus at the proximal portion of the utero-sacral ligaments. Urodynamics investigations show non specific hypoactive bladder and altered uroflowmetry. Concerning treatment, further controlled studies are needed to assess the hypothetical usefulness of parasympathomimetic and prokinetic agents for hypoactive bladder occurring after pelvic autonomic denervation. Neuromodulation is a successful treatment for patients with refractory lower urinary tract dysfunction. However, there is no controlled study that focused on its efficacy in voiding dysfunction after radical pelvic surgery. Overall, the main objective of the treatment is to avoid the complications of post-voiding residue (such as infection) and of abdominal pushing effort (deterioration of perineal tissues). Therefore, self catheterization should be recommended when this postoperative complication occurs. An understanding of the location of the autonomic pelvic network should help prevent iatrogenic injury through the adoption of surgical techniques, such as nerve sparing, that reduce postoperative autonomic dysfunction.
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Cited by (16)
- Sacral neuromodulation to treat voiding dysfunction in patients with previous pelvic surgery for deep infiltrating endometriosis: our centre's experience 2020
- Keep Your Landmarks Close and the Hypogastric Nerve Closer: An Approach to Nerve-sparing Endometriosis Surgery 2019
- Major and minor complications after resection without bowel resection for deeply infiltrating endometriosis 2018
- [Detrusor sphincter disorders associated with deep endometriosis: Systematic review of the literature] 2017
- Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results 2015
- [Urinary functional disorders bound to deep endometriosis and to its treatment: review of the literature] 2014
- Evaluation of urinary dysfunction by urodynamic tests, electromyography and quality of life questionnaire before and after surgery for deep infiltrating endometriosis 2014
- [Uterosacral ligament and hypogastric nerve anatomical relationship. Application to deep endometriotic nodules surgery] 2013
- Surgical Therapy of Endometriosis: Challenges and Controversies 2013
- Follow-up of dysfunctional bladder and rectum after surgery of a deep infiltrating rectovaginal endometriosis 2011
- Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome 2010
- Endometriosis infiltrante: revisión de tema Deep endometriosis: a review 2009
- Deep endometriosis: a review 2009
- Troubles urinaires associés au traitement chirurgical de l’endométriose profonde: intérêt de la chirurgie avec préservation nerveuse 2008
- Ein kombinierter Operationsansatz zur Therapie der rektovaginalen Endometriose auf der Basis histologischer Befunde 2008
- Histopathology-based combined surgical approach to rectovaginal endometriosis 2008
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