Gasparoni Mauro Poggiali, de Freitas Fonseca Marlon, Favorito Luciano Alves, da Silva Filho Fernando Salles, Diniz Andre Luiz Lima, Schuh Mathias Ferreira, Gomes Fernanda Hack, de Resende José Anacleto Dutra
Urology, Federal Hospital of Lagoa, Rua Pio Correa 110, 506, Jardim Botânico, Rio de Janeiro, 22462-240, Brazil.
Post-Graduation in Pathophysiology and Surgical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Arch Gynecol Obstet. 2024 Dec;310(6):3267-3278. doi: 10.1007/s00404-024-07842-2. Epub 2024 Nov 28.
This study sought to quantify the risks of urinary retention following different levels or degrees of nerve preservation during parametrectomies for deep endometriosis (DE).
Women undergoing laparoscopic and robotic nerve-sparing DE surgeries were studied. The cases were divided into 6 groups according to the degree of preservation of parasympathetic parametrium fibers on each side: P1 (P1 left /P1 right-Excellent preservation: presacral and pararectal fascia bilateral preservation), P2 (P1/P2 or P2/P1, P2/P2-Regular preservation: fascia violation with local fat visualization-either of both sides; and P3 (P1/P3 or P3/P1, P2/P3 or P3/P2, P3/P3)-Poor preservation: musculature and pelvic floor exposure-even if only unilateral.
Of a total of 151 women eligible for the study, 110 (72.8%) had excellent nerve preservation; 24 (15.8%) had regular nerve preservation, and 17 (11.2%) had poor-nerve preservation. The incidence of elevated PVR was higher in the P3 group. Thirty-five patients were catheterized post-operatively, more common in the P3 group. In four cases from the P3 group, prolonged intermittent self-catheterization after discharge was necessary. The calculated risk of needing intermittent catheterization in the P3 group was 23.1% up to 8 weeks and 7.7% up to 8 months post-surgery.
Parametrectomy with poor-nerve preservation can lead to urinary retention, even with excellent contralateral preservation.
本研究旨在量化深部子宫内膜异位症（DE）子宫旁组织切除术中不同程度或水平的神经保留后尿潴留的风险。
对接受腹腔镜和机器人保留神经的DE手术的女性进行研究。根据每侧副交感神经子宫旁组织纤维的保留程度，将病例分为6组：P1（P1左/P1右 - 极佳保留：双侧骶前和直肠旁筋膜保留），P2（P1/P2或P2/P1，P2/P2 - 常规保留：筋膜侵犯伴局部脂肪可见 - 双侧任一侧）；以及P3（P1/P3或P3/P1，P2/P3或P3/P2，P3/P3） - 保留不佳：肌肉组织和盆底暴露 - 即使仅为单侧。
在总共151名符合研究条件的女性中，110名（72.8%）神经保留极佳；24名（15.8%）神经保留常规，17名（11.2%）神经保留不佳。P3组膀胱残余尿量升高的发生率更高。35例患者术后留置导尿管，在P3组更常见。在P3组的4例病例中，出院后需要长期间歇性自我导尿。计算得出P3组术后8周内需间歇性导尿的风险为23.1%，术后8个月为7.7%。
神经保留不佳的子宫旁组织切除术可导致尿潴留，即使对侧保留极佳。
