Possover International Medical Center, Hirslanden Clinic, Zürich, Switzerland; and Department of Gynecology and Obstetrics, University of Aarhus, Aarhus, Denmark.
Fertil Steril. 2014 Mar;101(3):754-8. doi: 10.1016/j.fertnstert.2013.12.019. Epub 2014 Jan 11.
To investigate pathophysiologic mechanisms involved in bladder retention after surgery for rectovaginal deeply infiltrating endometriosis (DIE).
Retrospective case study.
Tertiary referral unit.
PATIENT(S): All patients who presented at our center over the last 5 years with bladder retention developed after laparoscopic surgery for rectovaginal or parametric DIE.
INTERVENTION(S): To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step workup including patient history, clinical neuropelveologic assessment, cystoscopy, and video-urodynamic testing with pelvic floor electromyography and rectomanometry.
MAIN OUTCOME MEASURE(S): Patient Perception of Bladder Condition, International Prostate Symptom Score, and the short-form version of the Urogenital Distress Inventory questionnaires.
RESULT(S): Forty-seven patients were investigated in this study. Mean (±SD) interval from the surgery was 9.5 years (±4.3; range, 7-15 years). Eighteen patients developed acute paralytic motor bladder atony and 5 acute neurogenic bladder atony. Twenty-four patients developed chronic neurogenic bladder atony. The first symptom of chronic bladder retention was reduction of urinary frequency (after 5 years on average). The most frequent complaints that made patients aware of difficulties in voiding were a weak urinary stream (appearing on average 7 years after the procedure) and the need for Valsalva or Crede maneuver (on average 9 years after the procedure).
CONCLUSION(S): Segmental rectum resection with parametric resection exposes the most patients to the risk of bladder motor paralytic retention. However, the most frequent etiology seems to be chronic myogenic destruction secondary to chronic bladder overdistention. Patients after surgery for DIE require a long follow-up, with particular attention paid to postvoid residual volumes.
研究直肠阴道深部浸润性子宫内膜异位症（DIE）手术后膀胱潴留的病理生理机制。
回顾性病例研究。
三级转诊单位。
过去 5 年来，在我们中心就诊的所有因腹腔镜直肠阴道或参数 DIE 手术后出现膀胱潴留的患者。
为了评估涉及这种主诉发病机制的机制，我们进行了逐步检查，包括病史、临床神经盆腔评估、膀胱镜检查以及带有盆底肌电图和直肠测压的视频尿动力学检查。
患者对膀胱状况的感知、国际前列腺症状评分和尿生殖窘迫量表的简短版本。
本研究共调查了 47 例患者。从手术到发病的平均（±SD）时间为 9.5 年（±4.3；范围，7-15 年）。18 例患者出现急性麻痹性动力性膀胱弛缓，5 例患者出现急性神经性膀胱弛缓。24 例患者出现慢性神经性膀胱弛缓。慢性膀胱潴留的第一个症状是尿频率减少（平均在术后 5 年）。使患者意识到排尿困难的最常见主诉是尿流微弱（平均在术后 7 年出现）和需要瓦尔萨尔瓦或克里德手法（平均在术后 9 年出现）。
节段性直肠切除和参数切除使大多数患者面临膀胱运动性麻痹性潴留的风险。然而，最常见的病因似乎是慢性膀胱过度膨胀引起的慢性肌源性破坏。DIE 手术后的患者需要长期随访，特别注意残余尿量。
