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

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL
Viktória Szántó, Balázs Kenyeres, Miklós Koppán
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引用次数: 0

摘要

骨盆后腔室深部子宫内膜异位症患者可能出现各种下尿路症状,包括尿潴留,病史中未做过盆腔手术。这些症状包括尿潴留、尿失禁或急迫性尿失禁、尿急和膀胱敏感性下降,暗示子宫内膜异位症病变浸润盆腔自主神经,并伴有炎症现象。虽然有许多关于子宫内膜异位症手术后重新出现尿功能障碍的出版物,但关于子宫内膜异位症手术专门用于改善子宫内膜异位症术前排尿功能障碍的效果的科学信息明显较少。因此,在本病例报告中,我们分析了腹腔镜子宫内膜异位症手术对一名28岁的未生育女性的影响,该女性术前尿潴留严重,需要每天三到四次清洁的间歇自我导尿。病史显示既往无盆腔或腹部手术,无任何神经或其他已知疾病。尿流仪显示明显的排尿功能障碍。膀胱充盈术显示膀胱感觉减少的迹象(400ml时有正常的排空欲望),同时保留了膀胱顺应性。在压力流研究期间,患者无法开始排尿,尽管记录了腹部紧张和逼尿肌收缩。排尿功能障碍的原因被认为是盆底功能障碍(排尿功能障碍)而不是逼尿肌活动不足。引入α受体阻滞剂、肌肉松弛疗法和盆底放松训练,短期效果不佳。经阴道超声检查显示两根子宫骶韧带在其颈部附着部位附近有低回声改变。用探针扫描时,这些区域似乎很痛。MRI检查证实了先前经阴道超声检查关于子宫内膜异位症特征的双侧子宫骶韧带改变的发现。在腹腔镜检查中,我们确认存在子宫内膜异位症病变的子宫骶韧带完全切除。术后患者排空功能明显改善。尿流仪也显示了排尿参数的改善。我们认为腹腔镜下切除子宫骶韧带子宫内膜异位症病变可以显著改善术前排尿功能障碍患者的膀胱功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Resection of Bilateral Endometriosis of the Uterosacral Ligaments Resolves Voiding Dysfunction: A Case Report

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.

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来源期刊
Clinical Case Reports
Clinical Case Reports MEDICINE, GENERAL & INTERNAL-
自引率
14.30%
发文量
1268
审稿时长
13 weeks
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).
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