Risk of urinary retention after nerve‐sparing surgery for deep infiltrating endometriosis: A systematic review and meta‐analysis

Júnior, José Anacleto Dutra de Resende; Cavalini, Luciana Tricai; Crispi, C.P.; Fonseca, Márlon de Freitas

doi:10.1002/nau.22915

Cited by 45 publications

(25 citation statements)

References 16 publications

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“…Deep endometriosis infiltrating the rectum may also involve uterosacral ligaments, vagina, parametrium, inferior hypogastric plexus and splanchnic nerves. Complete resection of large endometriosis lesions may induce postoperative dysfunction of vegetative nerves ( Possover, 2011 ; Bonneau et al , 2013 ; Roman et al , 2013b ; Darwish and Roman, 2017 ; de Resende et al , 2017 ). Despite the employment of nerve-sparing techniques ( Ceccaroni et al , 2012 ), it is obvious that inferior hypogastric plexus and splanchnic nerves may be injured by either the disease or the surgeon, resulting in various concerns with bowel and bladder function ( Darwish and Roman, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial

et al. 2017

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STUDY QUESTIONIs there a difference in functional outcome between conservative versus radical rectal surgery in patients with large deep endometriosis infiltrating the rectum 2 years postoperatively?SUMMARY ANSWERNo evidence was found that functional outcomes differed when conservative surgery was compared to radical rectal surgery for deeply invasive endometriosis involving the bowel.WHAT IS KNOWN ALREADYAdopting a conservative approach to the surgical management of deep endometriosis infiltrating the rectum, by employing shaving or disc excision, appears to yield improved digestive functional outcomes. However, previous comparative studies were not randomized, introducing a possible bias regarding the presumed superiority of conservative techniques due to the inclusion of patients with more severe deep endometriosis who underwent colorectal resection.STUDY DESIGN SIZE, DURATIONFrom March 2011 to August 2013, we performed a 2-arm randomized trial, enroling 60 patients with deep endometriosis infiltrating the rectum up to 15 cm from the anus, measuring more than 20 mm in length, involving at least the muscular layer in depth and up to 50% of rectal circumference. No women were lost to follow-up.PARTICIPANTS/MATERIALS, SETTING, METHODSPatients were enroled in three French university hospitals and had either conservative surgery, by shaving or disc excision, or radical rectal surgery, by segmental resection. Randomization was performed preoperatively using sequentially numbered, opaque, sealed envelopes, and patients were informed of the results of randomization. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation (1 stool/>5 consecutive days), frequent bowel movements (≥3 stools/day), defecation pain, anal incontinence, dysuria or bladder atony requiring self-catheterization 24 months postoperatively. Secondary endpoints were the values of the Visual Analog Scale (VAS), Knowles–Eccersley–Scott-Symptom Questionnaire (KESS), the Gastrointestinal Quality of Life Index (GIQLI), the Wexner scale, the Urinary Symptom Profile (USP) and the Short Form 36 Health Survey (SF36).MAIN RESULTS AND THE ROLE OF CHANCEA total of 60 patients were enroled. Among the 27 patients in the conservative surgery arm, two were converted to segmental resection (7.4%). In each group, 13 presented with at least one functional problem at 24 months after surgery (48.1 versus 39.4%, OR = 0.70, 95% CI 0.22–2.21). The intention-to-treat comparison of the overall scores on KESS, GIQLI, Wexner, USP and SF36 did not reveal significant differences between the two arms. Segmental resection was associated with a significant risk of bowel stenosis.LIMITATIONS REASONS FOR CAUTIONThe inclusion of only large infiltrations of the rectum does not allow the extrapolation of conclusions to small nodules of <20 mm in length. The presumption of a 40% difference favourable to conservative surgery in terms of postoperative functional outcomes resulted in a lack of power to demonstrate a difference for ...

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Section: Discussionmentioning

confidence: 99%

Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial

et al. 2017

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“…Different investigators have emphasized that, although complete excision of the endometriosis seems to offer significant improvement in sexual function, quality of life, and pelvic pain in symptomatic patients with DIE, surgery may be associated with complications and adverse new-onset symptoms and should be performed only after thorough consultation with the patient [ 25 ]. The current options for treatment may themselves have undesirable consequences, such as major urinary and bowel complications after surgery [ 26 27 ]. The present findings can help physicians discuss the possible interactions among the main endometriosis-associated symptoms and the differences in their impacts on HRQoL.…”

Section: Discussionmentioning

confidence: 99%

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study

Fonseca

Aragão²,

Sessa

et al. 2018

Obstet Gynecol Sci

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ObjectiveTo assess the correlation between different pain symptoms and different domains of women's health-related quality of life (HRQoL).MethodsSeventy-seven women with deep infiltrating endometriosis were successively enrolled between June 2011 and August 2013 while being prepared to undergo laparoscopy due to pain and/or infertility. We quantified the intensities of dysmenorrhea, deep dyspareunia, chronic pelvic pain, and dyschezia (menstrual and non-menstrual) using a 11-point visual analog scale (VAS: 0–10) and the validated full versions of the Short Form 36 (SF36) and Endometriosis Health Profile (EHP30) questionnaires to assess HRQoL. The pain symptoms were considered simultaneously in a hierarchical agglomerative clustering method (exploratory multivariate approach) and the associations among scores were tested by bivariate correlation.ResultsDysmenorrhea showed the lowest similarity on to the multivariate cluster analysis and no statistically significant correlation with the other pain symptoms: deep dyspareunia (P=0.244), chronic pelvic pain (P=0.108), menstrual dyschezia (P=0.238), and non-menstrual dyschezia (P=0.380). Dysmenorrhea and chronic pelvic pain were the main symptoms correlated with all domains of the SF36 and the EHP30 (core instrument) questionnaires (P<0.05).ConclusionDysmenorrhea and chronic pelvic pain were independent factors associated with HRQoL.

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“…Nerve-sparing (NS) techniques have been integrated in surgeries for deep infiltrating endometriosis (DIE) to prevent pelvic neurological complications, due to injury of autonomic nerves. This technique decreases the risk of persistent urinary retention when compared to the conventional (non-NS) technique [ 24 – 26 ]. The antioxidant therapy has also proven efficacy in the treatment and mitigation of endometriosis [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Endometriosis of the vesico-vaginal septum: a rare and unusual localization (case report)

2020

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Background: We report a rare and unusual case of endometriosis in the vesico-vaginal septum. The location of this disease at this site is so uncommon that the literature about is very rare. Case presentation: A 41-year-old female was presented with urinary symptoms. There was history of caesarean section. Physical examination revealed an anterior vaginal wall mass. Pelvic MRI showed an inter vesico-vaginal mass, suggesting a leiomyoma. Surgical excision was performed by the vaginal route. There were no postoperative complications. Histopathology examination showed focal endometriosis. Conclusion: Endometriosis of the anterior compartment remains relatively rare; its localization to the vesico-vaginal septum (VVS) is very rare. With the occurrence of nonspecific cyclic urinary signs in women during periods of genital activity, endometriosis should be mentioned, especially in the presence of an antecedent of pelvic surgery.

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Risk of urinary retention after nerve‐sparing surgery for deep infiltrating endometriosis: A systematic review and meta‐analysis

Cited by 45 publications

References 16 publications

Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial

Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study

Endometriosis of the vesico-vaginal septum: a rare and unusual localization (case report)

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