Gabriel Boris, Nassif Joseph, Trompoukis Pantelis, Lima Ana Maria, Barata Sonia, Lang-Avérous Gerlinde, Wattiez Arnaud
Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, IRCAD/EITS, 1, Place de l' Hopital, 67091 Strasbourg, France.
Int Urogynecol J. 2012 Jan;23(1):111-6. doi: 10.1007/s00192-011-1492-2. Epub 2011 Jul 6.
Urinary retention after radical laparoscopic surgery for severe endometriosis is a clinically relevant complication. We hypothesized a relationship between the amount of resected nerves and the occurrence of urinary retention.
We evaluated, retrospectively, a cohort of 221 patients. The expression of nerves in the resected specimens was investigated in patients with urinary retention and matched controls using standardized immunohistochemistry techniques.
The prevalence of urinary retention was 4.6% (n = 10). Importantly, there was no difference between cases and controls regarding the quantity of nerves in the resected specimens. The cumulative probability of 50% to overcome urinary retention was reached after 5.6 months. Age was the main risk factor for persistent retention (40.3 years with vs. 31.6 years without, p = 0.01).
In older endometriosis patients, surgical radicality should be balanced against preservation of organ function. There is a fairly good chance to recover, even after 6 months, which is important for patient counseling.
重度子宫内膜异位症行腹腔镜根治性手术后尿潴留是一种具有临床意义的并发症。我们推测切除神经的数量与尿潴留的发生之间存在关联。
我们对221例患者进行了回顾性评估。采用标准化免疫组织化学技术，对尿潴留患者及其匹配的对照组切除标本中的神经表达进行了研究。
尿潴留的发生率为4.6%（n = 10）。重要的是，切除标本中的神经数量在病例组和对照组之间没有差异。5.6个月后达到50%克服尿潴留的累积概率。年龄是持续性尿潴留的主要危险因素（有尿潴留者为40.3岁，无尿潴留者为31.6岁，p = 0.01）。
对于老年子宫内膜异位症患者，手术的根治性应与器官功能的保留相平衡。即使在6个月后，恢复的机会也相当大，这对患者咨询很重要。
