Combined vaginal-laparoscopic approach vs. laparoscopy alone for prevention of bladder voiding dysfunction after removal of large rectovaginal endometriosis

Roman H, H. Roman, Horace Roman, Eulalie Desnyder, Desnyder E, E Desnyder, Jennifer Pontré, J Pontré, C Hennetier, Clotilde Hennetier, Hennetier C, Clémence Klapczynski, Klapczynski C, C Klapczynski, P Collard, Collard P, Philippe Collard, Cornu JN, Jean‐Nicolas Cornu, J-N Cornu, J.-J. Tuech, Jean‐Jacques Tuech, Tuech JJ
Journal of visceral surgery · 2020 · vol. 158(2) , pp. 118–124 · doi:10.1016/j.jviscsurg.2020.07.004 · PMID:32747305 · W3046257456
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This study compared a combined vaginal-laparoscopic approach to laparoscopy alone for preventing bladder voiding dysfunction following the removal of large rectovaginal endometriosis.

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Abstract

Study objectiveTo assess whether the combined vaginal-laparoscopic route may reduce the risk of postoperative bladder atony, when compared to an exclusively laparoscopic approach, in patients presenting with deeply infiltrating rectovaginal endometriosis with extensive vaginal infiltration.DesignRetrospective comparative cohort study using data prospectively recorded in the CIRENDO database.SettingAcademic Tertiary Care Centre.PatientsOne hundred and thirty-two consecutive patients who underwent surgery of rectovaginal endometriosis with vaginal infiltration measuring greater than 3cm diameter.InterventionsCombined vaginal-laparoscopic versus laparoscopic approach.Measurement and main resultsSixty-two patients underwent excision of endometriosis via a combined vaginal-laparoscopic approach (study group, or cases), while 71 patients underwent surgery via an exclusively laparoscopic route (controls). Rates of preoperative cyclical voiding difficulty and sensation of incomplete bladder emptying were comparable between the two groups. Preoperative urodynamic assessment was carried out in 18% of cases and 38% of controls, with abnormal results in 27.3% and 11.1% of cases and controls respectively. Early postoperative voiding difficulty (post-void residual>100mL) occurred in 14.7% and 24.3% of cases and controls respectively. There was a significant reduction in risk of intermittent self-catheterisation of 13% at time of discharge in the study cases. Three months postoperatively, one case and 6 controls had persistent voiding dysfunction requiring prolonged self-catheterisation.ConclusionThe combined vaginal-laparoscopic approach for large rectovaginal endometriotic nodules could reduce the risk of postoperative bladder dysfunction, when compared to an exclusively laparoscopic approach, most likely due to a reduced risk of damage to the pelvic splanchnic nerves at the paravaginal level.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Laparoscopy Rectal Diseases Rectal Diseases Rectal Diseases Rectal Diseases Cohort Studies Female Humans Retrospective Studies Urinary Bladder

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