From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia; Endometriosis Centre, Hadassah-Hebrew University Medical Centre (Drs. Levin and Dior), Jerusalem, Israel.
From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia.
J Minim Invasive Gynecol. 2022 Feb;29(2):308-316.e2. doi: 10.1016/j.jmig.2021.08.024. Epub 2021 Aug 29.
To compare urinary function before and after surgery in patients undergoing laparoscopy for deep endometriosis and to measure the rate of postoperative deterioration in urinary function after surgery.
Prospective questionnaire-based observational cohort study.
Tertiary university-affiliated hospital.
Included were 149 women who underwent surgery for deep endometriosis.
Participants completed the international consultation on incontinence female lower urinary tract symptoms long-form questionnaire before surgery and 6 weeks, 6 months, and 12 months after surgery.
Bladder filling, voiding, and urinary incontinence summary scores were compared before and after surgery with mixed-effects linear regression analysis (correlated observations). Individual domains comprising the summary scores and their bother scores were also compared before and after surgery. Filling score at 6 weeks (3.7 ± 2.6), 6 months (3.2 ± 2.2), and 12 months (3.4 ± 2.2) improved from presurgery scores (4.2 ± 2.6) (p-value for the difference between before and after surgery: p <.001, p = .009, and p = .02 for 6 weeks, 6 months, and 12 months, respectively). No change was observed after surgery in bladder voiding score. Incontinence score improved at 6 weeks after surgery (presurgery and 6-week scores: 2.5 ± 3.3 and 1.6 ± 2.2, respectively, p <.001) but not thereafter. Patients with low preoperative summary scores had higher summary scores (worse function) after surgery, and patients with high preoperative scores had lower summary scores (improved function) after surgery.
Urinary function improved after laparoscopy for deep endometriosis. Greatest improvement was found in patients with worse preoperative function, whereas postoperative deterioration in urinary function was found for patients with initially normal function. More research is needed to better identify the subpopulations in whom surgical intervention provides symptomatic benefit or deterioration.
比较腹腔镜深部子宫内膜异位症患者手术前后的尿功能，并测量术后尿功能恶化的发生率。
前瞻性基于问卷的观察性队列研究。
三级大学附属医院。
纳入 149 名接受深部子宫内膜异位症手术的女性。
参与者在术前、术后 6 周、6 个月和 12 个月完成国际尿失禁咨询委员会下尿路症状问卷长表。
采用混合效应线性回归分析（相关观察）比较手术前后的膀胱充盈、排尿和尿失禁综合评分。还比较了综合评分及其困扰评分的各个领域在手术前后的情况。术后 6 周（3.7 ± 2.6）、6 个月（3.2 ± 2.2）和 12 个月（3.4 ± 2.2）的充盈评分较术前评分（4.2 ± 2.6）改善（手术前后评分差异的 p 值：分别为 p <.001、p =.009 和 p =.02）。术后膀胱排空评分无变化。术后 6 周时，失禁评分改善（术前和术后 6 周评分分别为 2.5 ± 3.3 和 1.6 ± 2.2，p <.001），但此后无变化。术前综合评分较低的患者术后综合评分较高（功能较差），而术前评分较高的患者术后综合评分较低（功能改善）。
腹腔镜深部子宫内膜异位症术后尿功能改善。术前功能较差的患者改善最大，而术前功能正常的患者术后尿功能恶化。需要进一步研究以更好地识别手术干预提供症状改善或恶化的亚人群。
