Troubles urinaires associés au traitement chirurgical de l’endométriose profonde: intérêt de la chirurgie avec préservation nerveuse

Résumé Après exérèse chirurgicale des lésions d’endométriose profonde (ligmanet[s] utérosacré[s] ou lors d’une résection rectale), les troubles urinaires de novo peuvent affecter jusqu’à 30 % des patientes avec une altération de la vidange vésicale. Ces troubles urinaires sont dus à des lésions des branches nerveuses des plexus hypogastriques inférieurs, lésions qui peuvent être uniou bilatérales. En pré-opératoire, les patientes doivent être informées de ce risque potentiel. La chirurgie avec préservation nerveuse permet de réduire de façon significative la survenue de ces troubles urinaires. En postopératoire, quand le résidu postmictionnel est supérieur à 100 ml et afin de prévenir le risque de complications, la réalisation d’autosondages est recommandée. L’évolution est le plus souvent favorable après quelques jours d’autosondages. Le recours à des épreuves urodynamiques et à des explorations électrophysiologiques s’avère nécessaire uniquement en cas de persistance des troubles urinaires. Abstract Urinary side effects occur in nearly 30% of patients after surgical resection of deep pelvic endometriosis and include significant voiding disorders. Damage to the autonomic pelvic nerves resulting from extensive surgery (unilateral or bilateral uterosacral ligament resections and/or colorectal resection) can explain this high-rate of symptoms. Preoperatively, patients must be clearly informed of this potential risk. Nerve-sparing surgery conserving the inferior hypogastric nerves significantly reduces the incidence of these urinary symptoms. When postvoid residual urine is greater than 100 ml, and to avoid complications, self-catheterization should be recommended. Usually, symptoms subside after a few days of self-catheterization, and urodynamic testing is required only if symptoms persist after this treatment. 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Int Urogynecol J Pelvic Floor Dysfunct 17: 248–252 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Dubernard, G., Huissoud, C., de Saint-Hilaire, P. et al. Troubles urinaires associés au traitement chirurgical de l’endométriose profonde: intérêt de la chirurgie avec préservation nerveuse. Pelv Perineol 3, 193–198 (2008). https://doi.org/10.1007/s11608-008-0198-5 Published: Issue date: DOI: https://doi.org/10.1007/s11608-008-0198-5