Unilateral nerve preservation during parametrectomy is not sufficient to prevent persistent urinary retention after cytoreductive endometriosis surgery.

IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Archives of Gynecology and Obstetrics Pub Date : 2024-12-01 Epub Date: 2024-11-28 DOI:10.1007/s00404-024-07842-2
Mauro Poggiali Gasparoni, Marlon de Freitas Fonseca, Luciano Alves Favorito, Fernando Salles da Silva Filho, Andre Luiz Lima Diniz, Mathias Ferreira Schuh, Fernanda Hack Gomes, José Anacleto Dutra de Resende
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引用次数: 0

Abstract

Objectives: This study sought to quantify the risks of urinary retention following different levels or degrees of nerve preservation during parametrectomies for deep endometriosis (DE).

Methods: Women undergoing laparoscopic and robotic nerve-sparing DE surgeries were studied. The cases were divided into 6 groups according to the degree of preservation of parasympathetic parametrium fibers on each side: P1 (P1 left /P1 right-Excellent preservation: presacral and pararectal fascia bilateral preservation), P2 (P1/P2 or P2/P1, P2/P2-Regular preservation: fascia violation with local fat visualization-either of both sides; and P3 (P1/P3 or P3/P1, P2/P3 or P3/P2, P3/P3)-Poor preservation: musculature and pelvic floor exposure-even if only unilateral.

Results: Of a total of 151 women eligible for the study, 110 (72.8%) had excellent nerve preservation; 24 (15.8%) had regular nerve preservation, and 17 (11.2%) had poor-nerve preservation. The incidence of elevated PVR was higher in the P3 group. Thirty-five patients were catheterized post-operatively, more common in the P3 group. In four cases from the P3 group, prolonged intermittent self-catheterization after discharge was necessary. The calculated risk of needing intermittent catheterization in the P3 group was 23.1% up to 8 weeks and 7.7% up to 8 months post-surgery.

Conclusion: Parametrectomy with poor-nerve preservation can lead to urinary retention, even with excellent contralateral preservation.

子宫内膜减缩手术后单侧神经保留不足以预防持续性尿潴留。
目的:本研究旨在量化深层子宫内膜异位症(DE)参数切除术中不同程度或不同程度的神经保留后尿潴留的风险。方法:对接受腹腔镜和机器人保神经DE手术的女性进行研究。根据每侧副交感神经参数纤维的保存程度分为6组:P1 (P1左/P1右),优秀保存:骶前和直肠旁筋膜双侧保存),P2 (P1/P2或P2/P1, P2/P2),常规保存:筋膜侵犯伴局部脂肪可见-两侧任意一方;P3 (P1/P3或P3/P1, P2/P3或P3/P2, P3/P3)-保存不良:肌肉组织和骨盆底暴露-即使只是单侧。结果:在151名符合研究条件的女性中,110名(72.8%)神经保存良好;神经保存正常者24例(15.8%),神经保存不良者17例(11.2%)。P3组PVR升高的发生率较高。术后留置导管35例,以P3组多见。P3组4例患者出院后需长时间间断自我导尿。P3组术后8周和8个月需要间歇置管的计算风险分别为23.1%和7.7%。结论:神经保存不良的参数切除可导致尿潴留,即使对侧保存良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.70
自引率
15.40%
发文量
493
审稿时长
1 months
期刊介绍: Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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