Prevalence and outcome of urinary retention after laparoscopic surgery for severe endometriosis—does histology provide answers?

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This retrospective study found 4.6% of patients experienced urinary retention after laparoscopic endometriosis surgery, with no difference in nerve quantity in resected tissue between cases and controls.

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This retrospective cohort study evaluated urinary retention after radical laparoscopic surgery for severe endometriosis in 221 patients, comparing those who developed urinary retention with matched controls using standardized immunohistochemistry to quantify nerves in resected specimens. Urinary retention occurred in 4.6% (10 patients), and there was no difference between cases and controls in the quantity of nerves present in the resected tissue. The cumulative probability of overcoming urinary retention reached 50% after 5.6 months, and age was identified as the main risk factor for persistent retention. This paper is centrally about endometriosis—specifically the prevalence and outcome of urinary retention after radical laparoscopic surgery and whether histologic nerve burden explains it.

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Abstract

Introduction and hypothesisUrinary retention after radical laparoscopic surgery for severe endometriosis is a clinically relevant complication. We hypothesized a relationship between the amount of resected nerves and the occurrence of urinary retention.MethodsWe evaluated, retrospectively, a cohort of 221 patients. The expression of nerves in the resected specimens was investigated in patients with urinary retention and matched controls using standardized immunohistochemistry techniques.ResultsThe prevalence of urinary retention was 4.6% (n = 10). Importantly, there was no difference between cases and controls regarding the quantity of nerves in the resected specimens. The cumulative probability of 50% to overcome urinary retention was reached after 5.6 months. Age was the main risk factor for persistent retention (40.3 years with vs. 31.6 years without, p = 0.01).ConclusionsIn older endometriosis patients, surgical radicality should be balanced against preservation of organ function. There is a fairly good chance to recover, even after 6 months, which is important for patient counseling.
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Abstract

Introduction and hypothesis Urinary retention after radical laparoscopic surgery for severe endometriosis is a clinically relevant complication. We hypothesized a relationship between the amount of resected nerves and the occurrence of urinary retention.

Methods

We evaluated, retrospectively, a cohort of 221 patients. The expression of nerves in the resected specimens was investigated in patients with urinary retention and matched controls using standardized immunohistochemistry techniques.

Results

The prevalence of urinary retention was 4.6% (n = 10). Importantly, there was no difference between cases and controls regarding the quantity of nerves in the resected specimens. The cumulative probability of 50% to overcome urinary retention was reached after 5.6 months. Age was the main risk factor for persistent retention (40.3 years with vs. 31.6 years without, p = 0.01).

Conclusions

In older endometriosis patients, surgical radicality should be balanced against preservation of organ function. There is a fairly good chance to recover, even after 6 months, which is important for patient counseling. Similar content being viewed by others

References

Marpeau O, Thomassin I, Barranger E et al (2004) Laparoscopic colorectal resection for endometriosis: preliminary results. J Gynecol Obstet Biol Reprod (Paris) 33(7):600–606 Volpi E, Ferrero A, Sismondi P (2004) Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis. Surg Endosc 18:1109–1112 Donnez J, Squifflet J (2010) Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 25(8):1949–1958 Campagnacci R, Perretta S, Guerrieri M et al (2005) Laparoscopic colorectal resection for endometriosis. Surg Endosc 19(5):662–664 Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Daraï E (2008) Urinary complications after surgery for posterior deep infiltrating endometriosis are related to the extent of dissection and to uterosacral ligaments resection. J Minim Invasive Gynecol 15(2):235–240 Nassif J, Trompoukis P, Barata S et al (2011) Management of deep endometriosis. RBM. doi:10.1016/j.rbmo:2010:08:012 Hockel M, Konerding MA, Heussel CP (1998) Liposuction-assisted nerve sparing extended radical hysterectomy: oncologic rationale, surgical anatomy and feasibility study. Am J Obstet Gynecol 178:971–976 Querleu D, Narducci F, Poulard V et al (2002) Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study. Gynecol Oncol 85:154–158 Possover M, Schneider A (2002) Slow-transit constipation after radical hysterectomy type III. Surg Endosc 16:847–850 Possover M, Stober 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 Kovoor E, Nassif J, Miranda-Mendoza I, Lang-Avérous G, Wattiez A (2010) Long-term urinary retention after laparoscopic surgery for deep endometriosis. Fertil Steril 95(2):803e9 Van Langendonckt A, Punyadeera C, Kamps R et al (2007) Identification of novel antigens in blood vessels in rectovaginal endometriosis. Mol Hum Reprod 13(12):875–886 Minelli L, Fanfani F, Fagotti A et al (2009) Laparoscopic colorectal resection for bowel endometriosis; feasibility, complications, and clinical outcome. Arch Surg 144:234–239 Acknowledgments We thank Dr. Eberst (Hautepierre Hospital, Strasbourg, France) for his support with the urodynamic investigation. Conflicts of interest None. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Gabriel, B., Nassif, J., Trompoukis, P. et al. Prevalence and outcome of urinary retention after laparoscopic surgery for severe endometriosis—does histology provide answers?. Int Urogynecol J 23, 111–116 (2012). https://doi.org/10.1007/s00192-011-1492-2 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00192-011-1492-2

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Condition tags

endometriosis

MeSH descriptors

Autonomic Pathways Endometriosis Endometriosis Laparoscopy Urinary Retention Adult Age Factors Autonomic Pathways Autonomic Pathways Endometriosis Female Humans Immunohistochemistry Kaplan-Meier Estimate Laparoscopy Prevalence Probability Retrospective Studies Time Factors Urinary Retention

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