Évaluation fonctionnelle urinaire et urodynamique préopératoire de patientes présentant une endométriose profonde pelvienne chirurgicale : à propos de 23 patientes

Les patientes atteintes d’endométriose profonde, dont la localisation touche les ligaments utérosacrés et/ou la face antérieure du rectum, présentent très fréquemment une symptomatologie fonctionnelle urinaire préopératoire. L’interrogatoire est fondamental dans l’évaluation de celle-ci, mais seul le bilan urodynamique permet de préciser l’atteinte réelle et de la quantifier. L’atteinte mise en évidence est une atteinte de type neurologique et vraisemblablement une atteinte du plexus hypogastrique inférieur: il ne s’agit pas d’une atteinte vésicale. Dans cette étude, il n’existe pas de corrélation entre les troubles préopératoires et la localisation péropératoire de la maladie. Une étude sur un plus grand nombre de patientes pourrait préciser les améliorations et complications éventuelles imputables à la chirurgie.

Abstract Coelioscopic surgery for deep endometriosis infiltrating the uterosacral ligaments and the rectum typically leads to postoperative mictional disorders, which can be attributed to nervous lesions of the presacral plexus whose nerve terminations can be damaged during the operation. However, patients presenting with this kind of pathology often describe urinary function symptoms before any surgery has taken place. Aim The aim of this study is to assess the existence of pre-existing mictional problems by carrying out a preoperative urodynamic assessment. Equipment and method This is a non-comparative descriptive cohort study of twenty-three consecutive patients consulting for surgical treatment of deep endometriosis with clinical and radiological infiltration of the uterosacral ligaments, the uterine torus and/or the rectum.

The mean age of the patients was 32.3 ± 6.2 years [19–42] at the time of treatment. Mean parity was 0.4 ± 0.87 children [0–2]. Deep endometriosis had been diagnosed through careful clinical examination and imaging techniques (supra-pubic endovaginal abdomino- pelvic ultrasonography and Magnetic Resonance Imaging [MRI]). Six patients had no history of urinary problems (26.1%). The remaining 17 presented at least one of the following signs: increased daytime frequency, urinary incontinence, straining to urinate, increased night-time frequency, urgency, mictional burns, bladder cramps, reduced bladder sensitivity (possible urine infections were systematically eliminated). The imaging techniques enabled diagnosis of 5 cases of adnexal lesion, (21.7% of cases), 7 cases of adenomyosis (30.4%), 14 cases of rectal endometriosis (60.8%), 16 cases of endometriosis of the uterine torus (69.6%) and 18 cases of endometriosis of the uterosacral ligaments (78.3%). There was a single case of vesical endometriosis (4.3%). The urodynamic assessment carried out preoperatively was totally normal for only 4 patients (17.4%). Three patients had significant post-mictional residue, (13.0%), of which one case was pathological (over 100 ml). The average urethral closure pressure was 85.5 ± 28.6 cmH2O [38–150]. Nine patients presented urethral hypertonia (39.1%), four had urethral instability (17.4%), four dysuria (17.4%), four hypersensitive bladder (17.4%), three urethral sphincter insufficiency (13.0%), two had a large hypoesthetic bladder with limited closure pressure (8.7%) and one had small bladder capacity (4.3%).

Patients with deep endometriosis in the area of the uterosacral ligaments and/or the anterior face of the rectum very often-present urinary function problems in the preoperative period. It is essential to take a history of symptoms in order to detect this, but only an urodynamic assessment can determine the extent of the damage and quantify it. The disorder revealed is of neurological origin, probably related to lesions of the inferior hypogastric plexus rather than of the bladder. This study did not show any correlation between preoperative disorders and the localisation of the lesions found during the operation. A study of a larger number of patients may indicate further improvements and possible complications that might arise following surgery. Références Gehrich AP, Aseff JN, Iglesia CB, et al. (2005) Chronic urinary retention and pelvic floor hypertonicity after surgery for endometriosis: A case series. Am J Obstet Gynecol 193: 2133–2137 Thomassin I, Bazot M, Detchev R, et al. (2004) Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography. Am J Obstet Gynecol 190(5): 1264–1271 Panel P, Chis C, Gaudin S, et al. (2006) Laparoscopic surgery of deep endometriosis. About 118 cases. Gynecol Obstet Fertil 34: 583–592 Darai E, Thomassin, I, Barranger E, et al. (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192: 394–400 Possover M, Stöber S, Plaul K, Schneider A (2000) Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III. Gynecol Oncol 79: 154–157 Zanolla R, Torelli T, Campo B, Ordesi G (1988) Micturitional dysfunction after anterior resection for rectal cancer. Rehabilitative treatment. Dis Colon Rectum 31: 707–709 Volpi E, Ferrero A, Sismondi P (2004) Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis. Surg Endosc 18: 1109–1112 Possover M, Quakernack J, Chiantera V (2005) The LANN technique to reduce postoperative function morbidity in laparoscopic radical pelvic surgery. J Am Coll Surg 201: 913–917 Fauconnier A, Chapron C (2005) Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update 11: 595–606 [Epub 2005 Sep 19] Haab F, Amarenco G, Coloby P, et al. (2004) Terminology of lower urinary tract dysfunction: French adaptation of the terminology of the International Continence Society. Prog Urol 14(6): 1103–1111 (2005) Dysfonctionnements du plancher pelvien. Tome 1. Physiopathologie et investigations. Alain P. Bourcier, Edward J, McGuire, Paul Abrams (eds). Elsevier Kamina P (2000) Anatomie opératoire. Gynécologie et obstétrique. Ed Maloine Chaliha C, Bland JM, Monga A, et al. (2000) Pregnancy and delivery: an urodynamic viewpoint. BJOG 107: 1354–1359 Abrams P, Blaivas JG, Stanton SL, Andersen JT (1988) The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol Suppl 114: 5–19 Abrams P, Blaivas JG, Stanton SL, Anderson JT (1990) The standardization of terminology of lower urinary tract function. Br J Obstet Gynaecol 97(Suppl 6): 1 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article de Lapasse, C., Chis, C., Renouvel, F. et al. Évaluation fonctionnelle urinaire et urodynamique préopératoire de patientes présentant une endométriose profonde pelvienne chirurgicale : à propos de 23 patientes. Pelv Perineol 3, 279–283 (2008). https://doi.org/10.1007/s11608-008-0217-6 Published: Issue date: DOI: https://doi.org/10.1007/s11608-008-0217-6