{"title":"切除双侧子宫骶韧带子宫内膜异位症解决排尿功能障碍1例报告","authors":"Viktória Szántó, Balázs Kenyeres, Miklós Koppán","doi":"10.1002/ccr3.70929","DOIUrl":null,"url":null,"abstract":"<p>Patients with deep endometriosis of the posterior pelvic compartment might present various lower urinary tract symptoms, including urinary retention, without any prior pelvic surgery in their medical history. These symptoms, including urinary retention, pollakiuria or urge incontinence, urinary urgency, and decreased bladder sensitivity, imply an infiltration of the pelvic autonomic nerves by endometriosis lesions, in combination with inflammatory phenomena. Although there are numerous publications dealing with de novo urinary dysfunction after endometriosis surgery, significantly less scientific information is available on the effect of endometriosis surgery specifically tailored to improve preoperative voiding dysfunction in endometriosis. Therefore, in this case report, we analyze the effect of laparoscopic endometriosis surgery in a 28-year-old nulliparous woman with serious preoperative urinary retention mandating clean intermittent self-catheterization three to four times daily. Patient history revealed neither prior pelvic nor abdominal operation, nor any neurological or other known disease. Uroflowmetry demonstrated significant voiding dysfunction. Filling cystometry showed signs of reduced bladder sensation (normal desire to void at 400 mL) along with preserved bladder compliance. During the pressure-flow study, the patient was unable to initiate micturition, although abdominal straining and detrusor contraction were registered. The cause of voiding dysfunction was deemed to be pelvic floor dysfunction (dysfunctional voiding) rather than detrusor underactivity. Alpha blocker, muscle relaxant therapy, and pelvic floor relaxation training were introduced, achieving poor short-term response. Transvaginal ultrasound examination showed hypoechogenic alterations on both uterosacral ligaments in the vicinity of their cervical attachment sites. These areas appeared to be painful while scanning with the probe. MRI examination confirmed the previous finding of transvaginal ultrasound with regard to bilateral alteration of the uterosacral ligaments characteristic of endometriosis. During laparoscopy, we confirmed the presence of endometriotic lesions of both uterosacral ligaments that were completely removed. The patient showed significantly improved emptying function following surgery. Uroflowmetry also demonstrated improved voiding parameters. We conclude that laparoscopic removal of endometriotic lesions of the uterosacral ligaments can significantly improve bladder function in patients suffering from preoperative voiding dysfunction.</p>","PeriodicalId":10327,"journal":{"name":"Clinical Case Reports","volume":"13 10","pages":""},"PeriodicalIF":0.6000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccr3.70929","citationCount":"0","resultStr":"{\"title\":\"Resection of Bilateral Endometriosis of the Uterosacral Ligaments Resolves Voiding Dysfunction: A Case Report\",\"authors\":\"Viktória Szántó, Balázs Kenyeres, Miklós Koppán\",\"doi\":\"10.1002/ccr3.70929\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Patients with deep endometriosis of the posterior pelvic compartment might present various lower urinary tract symptoms, including urinary retention, without any prior pelvic surgery in their medical history. These symptoms, including urinary retention, pollakiuria or urge incontinence, urinary urgency, and decreased bladder sensitivity, imply an infiltration of the pelvic autonomic nerves by endometriosis lesions, in combination with inflammatory phenomena. Although there are numerous publications dealing with de novo urinary dysfunction after endometriosis surgery, significantly less scientific information is available on the effect of endometriosis surgery specifically tailored to improve preoperative voiding dysfunction in endometriosis. Therefore, in this case report, we analyze the effect of laparoscopic endometriosis surgery in a 28-year-old nulliparous woman with serious preoperative urinary retention mandating clean intermittent self-catheterization three to four times daily. Patient history revealed neither prior pelvic nor abdominal operation, nor any neurological or other known disease. Uroflowmetry demonstrated significant voiding dysfunction. Filling cystometry showed signs of reduced bladder sensation (normal desire to void at 400 mL) along with preserved bladder compliance. During the pressure-flow study, the patient was unable to initiate micturition, although abdominal straining and detrusor contraction were registered. The cause of voiding dysfunction was deemed to be pelvic floor dysfunction (dysfunctional voiding) rather than detrusor underactivity. Alpha blocker, muscle relaxant therapy, and pelvic floor relaxation training were introduced, achieving poor short-term response. Transvaginal ultrasound examination showed hypoechogenic alterations on both uterosacral ligaments in the vicinity of their cervical attachment sites. These areas appeared to be painful while scanning with the probe. MRI examination confirmed the previous finding of transvaginal ultrasound with regard to bilateral alteration of the uterosacral ligaments characteristic of endometriosis. During laparoscopy, we confirmed the presence of endometriotic lesions of both uterosacral ligaments that were completely removed. The patient showed significantly improved emptying function following surgery. Uroflowmetry also demonstrated improved voiding parameters. We conclude that laparoscopic removal of endometriotic lesions of the uterosacral ligaments can significantly improve bladder function in patients suffering from preoperative voiding dysfunction.</p>\",\"PeriodicalId\":10327,\"journal\":{\"name\":\"Clinical Case Reports\",\"volume\":\"13 10\",\"pages\":\"\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccr3.70929\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ccr3.70929\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccr3.70929","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Resection of Bilateral Endometriosis of the Uterosacral Ligaments Resolves Voiding Dysfunction: A Case Report
Patients with deep endometriosis of the posterior pelvic compartment might present various lower urinary tract symptoms, including urinary retention, without any prior pelvic surgery in their medical history. These symptoms, including urinary retention, pollakiuria or urge incontinence, urinary urgency, and decreased bladder sensitivity, imply an infiltration of the pelvic autonomic nerves by endometriosis lesions, in combination with inflammatory phenomena. Although there are numerous publications dealing with de novo urinary dysfunction after endometriosis surgery, significantly less scientific information is available on the effect of endometriosis surgery specifically tailored to improve preoperative voiding dysfunction in endometriosis. Therefore, in this case report, we analyze the effect of laparoscopic endometriosis surgery in a 28-year-old nulliparous woman with serious preoperative urinary retention mandating clean intermittent self-catheterization three to four times daily. Patient history revealed neither prior pelvic nor abdominal operation, nor any neurological or other known disease. Uroflowmetry demonstrated significant voiding dysfunction. Filling cystometry showed signs of reduced bladder sensation (normal desire to void at 400 mL) along with preserved bladder compliance. During the pressure-flow study, the patient was unable to initiate micturition, although abdominal straining and detrusor contraction were registered. The cause of voiding dysfunction was deemed to be pelvic floor dysfunction (dysfunctional voiding) rather than detrusor underactivity. Alpha blocker, muscle relaxant therapy, and pelvic floor relaxation training were introduced, achieving poor short-term response. Transvaginal ultrasound examination showed hypoechogenic alterations on both uterosacral ligaments in the vicinity of their cervical attachment sites. These areas appeared to be painful while scanning with the probe. MRI examination confirmed the previous finding of transvaginal ultrasound with regard to bilateral alteration of the uterosacral ligaments characteristic of endometriosis. During laparoscopy, we confirmed the presence of endometriotic lesions of both uterosacral ligaments that were completely removed. The patient showed significantly improved emptying function following surgery. Uroflowmetry also demonstrated improved voiding parameters. We conclude that laparoscopic removal of endometriotic lesions of the uterosacral ligaments can significantly improve bladder function in patients suffering from preoperative voiding dysfunction.
期刊介绍:
Clinical Case Reports is different from other case report journals. Our aim is to directly improve global health and increase clinical understanding using case reports to convey important best practice information. We welcome case reports from all areas of Medicine, Nursing, Dentistry, and Veterinary Science and may include: -Any clinical case or procedure which illustrates an important best practice teaching message -Any clinical case or procedure which illustrates the appropriate use of an important clinical guideline or systematic review. As well as: -The management of novel or very uncommon diseases -A common disease presenting in an uncommon way -An uncommon disease masquerading as something more common -Cases which expand understanding of disease pathogenesis -Cases where the teaching point is based on an error -Cases which allow us to re-think established medical lore -Unreported adverse effects of interventions (drug, procedural, or other).