Abstract
Introduction and hypothesisVoiding symptoms/dysfunctions (VS/Ds) after surgery for deep-infiltrating endometriosis (DIE) are frequent (20% of patients) and, together with bowel dysfunctions, may represent a de novo disorder due to surgical damage of the pelvic plexus or a worsening of pre-existent functional damage. Sacral neuromodulation (SNM) might improve voiding symptoms by treating dysfunctional voiding. The aim of this study is to report our experience with SNM in patients treated with surgery for DIE.MethodsWe retrospectively enrolled 13 patients with VS/Ds after surgery for DIE. All patients were investigated with urodynamic studies (UDS) and agreed to undergo SNM. Pre-existing VS/Ds, bowel disorders and pelvic pain, DIE surgical procedures, UDS and SNM test results were recorded.ResultsAfter surgery for DIE, functional bladder outflow obstruction and detrusor acontractility were observed in nine and four patients, respectively. Chronic pelvic pain was present in seven cases. Twelve patients developed constipation, whilst one patient had de novo faecal incontinence. After the SNM testing period, nine patients (69.2%) experienced a significant improvement of symptoms that led to definitive implant. Four patients (30.8%) had no symptom relief and the system was removed.ConclusionsFunctional bladder outflow obstruction and urinary retention are the most common VS/Ds after surgery for DIE. SNM may be an effective option for these patients, probably due to its action in improving the dysfunctional voiding, which was likely to be already present as part of the “endometriotic syndrome” and got worse after pelvic surgery. Results for pelvic pain control and gastrointestinal disorders should not be underestimated.
Highlights
Introduction and hypothesisVoiding symptoms/dysfunctions (VS/Ds) after surgery for deep-infiltrating endometriosis (DIE) are frequent (20% of patients) and, together with bowel dysfunctions, may represent a de novo disorder due to surgical damage of the pelvic plexus or a worsening of pre-existent functional damage
Bladder acontractility was diagnosed when a complete absence of detrusor pressure waves was observed on pressure-flow studies (PFS), regardless of the post-voided residual and maximum flow rate
Pelvic surgery for deep-infiltrating endometriosis is frequently associated with VS/Ds, mainly because of incomplete bladder emptying and increased post-voided residual
Summary
Introduction and hypothesisVoiding symptoms/dysfunctions (VS/Ds) after surgery for deep-infiltrating endometriosis (DIE) are frequent (20% of patients) and, together with bowel dysfunctions, may represent a de novo disorder due to surgical damage of the pelvic plexus or a worsening of pre-existent functional damage. The term “deep-infiltrating endometriosis” (DIE) should be reserved for lesions in the retroperitoneal tissue (i.e., at sites different from those of “ordinary” lesions) but, for practical purposes, it includes lesions penetrating anatomical pelvic structures, mainly of the posterior compartment (93.4% of cases) [2], such as the utero-sacral ligaments, bowel, bladder, vaginal wall and ureters. These lesions may greatly alter the quality of life because of severe pain at menstruation and intercourse and pose difficult surgical problems [3]. Due to the poor efficacy of medical treatments, Int Urogynecol J (2021) 32:1499–1504 symptomatic women affected by DIE are advised to undergo surgery
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