Ballester Marcos, Dubernard Gil, Wafo Estelle, Bellon Laura, Amarenco Gérard, Belghiti Jeremie, Daraï Emile
Department of Gynecology and Obstetrics, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, France.
Department of Neuro-urology and Electrophysiological Explorations, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, France.
Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:135-40. doi: 10.1016/j.ejogrb.2014.05.041. Epub 2014 Jun 5.
To evaluate urinary dysfunction and quality of life before and after surgery for deep infiltrating endometriosis (DIE).
This prospective study included 50 patients with DIE who required surgery. Urinary dysfunction was evaluated before and after surgery by both urodynamic tests and electromyography, and the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) quality-of-life questionnaire.
Preoperative electromyography showed that 14 patients (28%) had neurogenic alteration involving sacral reflex and pelvic floor muscles correlated with the presence of colorectal endometriosis (p=0.003). Postoperative quality of life and BFLUTS total scores were improved compared to preoperative scores (p=0.001 and p=0.005, respectively). After an initial improvement in BFLUTS, an alteration is observed at long-term (median follow-up of 66 months). In the 34 patients with pre- and postoperative urodynamic measurements, no difference was found before and after surgery. De novo peripheral neuropathy was only observed in patients who underwent DIE resection with colorectal resection (p=0.02).
Our results support that patients with DIE have a high incidence of preoperative urinary symptoms and neurogenic dysfunction. Colorectal resection appears to be a determinant factor of de novo peripheral neuropathy.
评估深部浸润性子宫内膜异位症（DIE）手术前后的排尿功能障碍及生活质量。
这项前瞻性研究纳入了50例需要手术治疗的DIE患者。通过尿动力学检查和肌电图以及布里斯托尔女性下尿路症状（BFLUTS）生活质量问卷对手术前后的排尿功能障碍进行评估。
术前肌电图显示，14例患者（28%）存在涉及骶反射和盆底肌肉的神经源性改变，这与结直肠子宫内膜异位症的存在相关（p = 0.003）。与术前评分相比，术后生活质量和BFLUTS总分均有所改善（分别为p = 0.001和p = 0.005）。在BFLUTS最初改善后，长期（中位随访66个月）观察到有改变。在34例术前后均进行尿动力学测量的患者中，手术前后未发现差异。新发周围神经病变仅在接受DIE切除联合结直肠切除的患者中观察到（p = 0.02）。
我们的结果支持DIE患者术前排尿症状和神经源性功能障碍的发生率较高。结直肠切除似乎是新发周围神经病变的一个决定性因素。
