Madar Alexandra, Crestani Adrien, Eraud Patrick, Spiers Andrew, Constantin Alin, Chiche Fréderic, Furet Elise, Collinet Pierre, Touboul Cyril, Merlot Benjamin, Roman Horace, Dabi Yohann, Bendifallah Sofiane
Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France.
Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E), Paris, France.
Updates Surg. 2025 Feb 7. doi: 10.1007/s13304-025-02124-1.
To define the risk factors of post-operative voiding dysfunction according to the type of surgical procedure performed. A systematic review through PubMed, the Cochrane Library, and Web of Science databases was performed. The Medical Subject Headings terms aimed for English articles about colorectal endometriosis surgery and voiding dysfunction published until December 26, 2022 were used. The primary outcome was the occurrence of post-operative voiding dysfunction. Secondary outcome was the presence of a persistent voiding dysfunction at 1 month. MeSH terms included ''deep endometriosis'', ''surgery'', or ''voiding dysfunction''. Two reviewers (AM, PE) assessed the quality of each article independently. A Study Quality Assessment Tool was used to provide rating of the quality of the included studies. 22 studies were included in the final analysis. Rectal shaving was associated with less voiding dysfunction than segmental resection (OR 0.33; 95%CI [0.20: 0.54]; I = 0%; p < 10). No difference was found between rectal shaving and discoid excision (OR 0.44; 95%CI [0.07: 2.84]; I = 55%; p = 0.39), nor between discoid excision and segmental resection (OR 0.44; 95%CI [0.18: 1.09]; I = 49%; p = 0.08). Conservative surgery (i.e., shaving and discoid) was associated with less voiding dysfunction than radical surgery (i.e., segmental resection) (OR 0.37; 95%CI [0.25: 0.55]; I = 0%; p < 10). Regarding persistent voiding dysfunction, rectal shaving and discoid excision were less associated with voiding dysfunction than segmental resection (respectively, OR 0.30; 95%CI [0.14: 0.66]; I = 0%; p = 0.003 and OR 0.13; 95%CI [0.03: 0.57]; I = 0%; p = 0.007). Conservative bowel procedures are associated with lower rates of persistent post-operative voiding dysfunction and should be considered first when possible.Trial registration: Our meta-analysis was registered under the PROSPERO number: CRD42023395356.
根据所实施的手术类型来确定术后排尿功能障碍的风险因素。通过PubMed、Cochrane图书馆和Web of Science数据库进行了系统综述。使用医学主题词检索截至2022年12月26日发表的关于结直肠子宫内膜异位症手术和排尿功能障碍的英文文章。主要结局是术后排尿功能障碍的发生情况。次要结局是术后1个月持续性排尿功能障碍的存在情况。医学主题词包括“深部子宫内膜异位症”“手术”或“排尿功能障碍”。两名评审员（AM、PE）独立评估每篇文章的质量。使用研究质量评估工具对纳入研究的质量进行评分。最终分析纳入了22项研究。直肠削除术与节段性切除术相比，排尿功能障碍较少（比值比0.33；95%置信区间[0.20:0.54]；I² = 0%；p < 0.01）。直肠削除术与盘状切除术之间未发现差异（比值比0.44；95%置信区间[0.07:2.84]；I² = 55%；p = 0.39），盘状切除术与节段性切除术之间也未发现差异（比值比0.44；95%置信区间[0.18:1.09]；I² = 49%；p = 0.08）。保守性手术（即削除术和盘状切除术）与根治性手术（即节段性切除术）相比，排尿功能障碍较少（比值比0.37；95%置信区间[0.25:0.55]；I² = 0%；p < 0.01）。关于持续性排尿功能障碍，直肠削除术和盘状切除术与节段性切除术相比，与排尿功能障碍的关联较小（分别为比值比0.30；95%置信区间[0.14:0.66]；I² = 0%；p = 0.003和比值比0.13；95%置信区间[0.03:0.57]；I² = 0%；p = 0.007）。保守性肠道手术与术后持续性排尿功能障碍的发生率较低相关，如有可能应首先考虑。试验注册：我们的荟萃分析在PROSPERO注册号下注册：CRD42023395356。
