Urine Double Trouble: A Case of Voiding Dysfunction Following Gynecologic Surgery

Abstract

<h3>Study Objective</h3> We present a surgical video that demonstrates postoperative voiding dysfunction following laparoscopic excision of deeply infiltrative endometriosis with rectal involvement. This video highlights the relevant anatomy and physiology involved in postoperative voiding dysfunction. <h3>Design</h3> Surgical Educational Video. <h3>Setting</h3> Tertiary Referral Center at an Academic Residency Program. <h3>Patients or Participants</h3> 37-yo G1P1 with symptomatic deep endometriosis, presenting with a 4cm deeply infiltrative endometriotic rectal nodule. <h3>Interventions</h3> Laparoscopic excision of deeply infiltrative endometriosis and excision of rectal nodule with low anterior bowel resection. <h3>Measurements and Main Results</h3> Excision of deep infiltrating endometriosis within the pararectal fossae and parametria as well as resection of 4 cm rectal endometriotic lesion. Postoperative urinary retention led to bladder overdistension injury and subsequent chronic voiding dysfunction. <h3>Conclusion</h3> Postoperative voiding dysfunction and bladder overdistension is a common postoperative injury that can have long-term consequences. Gynecologic patients may present with multiple risk factors. Understanding the pathophysiology, surgical anatomy, signs and symptoms, and immediate treatment recommendations is important for both the generalist and specialist gynecologist.