Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

Donval L, Lou Donval, Niro J, Julien Niro, J. Niro, Thomas Gaillard, Gaillard T, Sarah Amari, Amari S, Chis C, C. Chis, Carmen Chis, Clothilde Poupon, Poupon C, Gauthier A, Anne-Sophie Gauthier, Anne Gauthier, Panel P, Pierre Panel, P. Panel
Journal of minimally invasive gynecology · 2022 · vol. 29(5) , pp. 656–664 · doi:10.1016/j.jmig.2022.01.003 · PMID:35063645 · W4205518626
article OA: closed CC0 ⤵ 4 in-corpus citations
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This study developed and validated a nomogram to predict the need for a complex ureteral procedure during pelvic endometriosis surgery, aiming to improve surgical planning and patient outcomes.

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Abstract

Study objectiveTo develop a nomogram for predicting the type of ureteral procedure in pelvic deep endometriosis (DE) surgery (1) and to describe the factors and complications associated with the ureteral procedure (2).DesignRetrospective monocentric study of 920 patients who underwent surgery for pelvic DE between June 2009 and March 2020 in the gynecologic surgery department of the Versailles Hospital Center. The main criterion was evaluation of the ureteral procedure, classified as simple (isolation of the ureter) or complex (dissection of the ureter, segmental ureteral resection, or nephroureterectomy). Postoperative complications, including ureteral stenosis and fistula formation, were tabulated.SettingTertiary referral hospital and expert center in endometriosis.PatientsA total of 920 patients with DE.InterventionsUreteral procedure during surgery for DE.Measurements and main resultsIn total, 724 patients (79%) underwent a ureteral procedure, of which 307 (33%) were complex, including 17 (1.8%) segmental ureteral resections. In multivariate analysis, the predictive variables for a complex ureteral procedure were age (p = .036), a previous surgery for endometriosis (p <.01), and ureteral dilatation on magnetic resonance imaging (p <.001). The area under the curve for the model predicting a complex ureteral procedure was 0.68 (95% confidence interval, 0.60-0.71). A complex ureteral procedure was associated with a 3.5% rate of ureteral fistula (n = 15).ConclusionAge, a previous surgery for endometriosis, a rectovaginal nodule size ≥30 mm, endometriotic involvement of the rectum or sigmoid, and ureteral dilatation are significantly associated with a complex ureteral procedure. Our results allowed us to build a nomogram that can be used to better inform patients, anticipate the therapeutic strategy, and optimize the modalities of postoperative surveillance.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy Ureter Ureter Ureteral Diseases Ureteral Diseases Female Humans Nomograms Retrospective Studies Treatment Outcome

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