Service de Gynécologie-Obstétrique, Hôpital Tenon, Paris, France.
J Minim Invasive Gynecol. 2013 Jan-Feb;20(1):49-55. doi: 10.1016/j.jmig.2012.08.775. Epub 2012 Nov 4.
To evaluate urologic complications after colorectal resection for endometriosis.
Cohort study (Canadian Task Force classification II-2).
Tertiary referral university hospital and expert center in endometriosis.
One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging.
Open or laparoscopic colorectal resection for endometriosis.
Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003).
Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed.
评估子宫内膜异位症直肠结肠切除术的泌尿系统并发症。
队列研究(加拿大任务组分类 II-2)。
三级转诊大学医院和子宫内膜异位症专家中心。
166 例经阴道超声和磁共振成像证实为直肠子宫内膜异位症的女性。
开腹或腹腔镜直肠结肠切除术治疗子宫内膜异位症。
44 例(26.5%)至少发生 1 种泌尿系统并发症,包括感染。8 例(4.8%)患者术后出现症状性肾盂积水,3 例需要输尿管支架置入,1 例需要经皮肾造瘘术,4 例患者采取保守治疗。5 例(3%)发生泌尿系统瘘。48 例(28.9%)患者术后出现排尿功能障碍,需要自行导尿。单因素分析发现,排尿功能障碍与部分结肠切除术(p =.001)和美国生殖医学协会总评分(p =.02)有关,而尿瘘的发生与预防性输尿管置管(p =.015)和宫旁切除术(p =.02)有关。术后症状性肾盂积水与预防性输尿管置管(p =.003)有关。
直肠结肠切除术治疗子宫内膜异位症可导致泌尿系统并发症,特别是对于需要部分结肠切除术的患者,需要告知患者这些风险。