Évaluation fonctionnelle urinaire et urodynamique préopératoire des patientes présentant une endométriose profonde pelvienne chirurgicale : à propos de 12 cas

Abstract

Objectives Laparoscopic surgery of deep endometriosis, including uterosacral ligament and rectal localisation, generally induces postoperative urinary disorders, caused by sacral plexus nerve lesions. However, during presurgical consultation, patients with these symptoms frequently present some urinary disorders. Our objective was to prospectively evaluate the reality of preexistant urinary disorders by performing urodynamic tests. Patients and methods This study is a prospective, descriptive and non-comparative study about 12 consecutive patients consulting for a surgical assumption of deep endometriosis, including clinical and radiological lesions on the uterosacral ligaments, on the uterine torus and/or on the rectum. Results A total of 12 patients whose ages ranged from 24 to 42 (mean age 34.6 ± 5.3 years). The mean parity was 0.5 ± 0.8 children (0–2). A clinical examination and multiple preoperative imaging techniques (abdominopelvic ultrasonography [US] and Magnetic Resonance Imaging [MRI]) were used to diagnose a deep endometriosis. During consultation, four patients presented no urinary dysfunction (33%). The eight other patients presented at least one of the following symptoms: increased daytime frequency, urinary incontinence, straining, increased night time frequency, urgency, mictional burns, bladder cramps, reduction in the bladder sensation. Any urinary infection was systematically eliminated. Multiple imaging techniques allowed to diagnose: an adnexal lesion in three cases (25%), adenomyosis in three cases (25%). Endometriosis was detected on the rectum in eight cases (66.7%), on the uterine torus in nine cases (75%) and on the uterosacral ligaments in 10 cases (83.3%). No vesical localisation was found. The urodynamic tests performed before surgery were totally normal in only two cases (16.7%). Three patients had a true postmictional residue (25%), but only one was pathological (more than 100 mL). The mean urethral fence pressure was 87.8 ± 33.5 cm H20 (38–150). Four patients had a urethral hypertonia (30%), three patients a urethral instability (25%), three patients a dysuria (25%), two patients a hypersensitive bladder (16.7%), two patients had an insufficiency of the urethral sphincter (16.7%), one patient a big hypoesthetic bladder (8.3%) and one patient a small bladder capacity. Discussion and conclusion Patients with deep endometriosis on the uterosacral ligaments and/or on the former face of the rectum frequently have urinary disorders. Consulting such patients is fundamental since it allows to diagnose them but it is not sufficient. Performing urodynamic tests can precisely determine and quantify real disorders. These disorders are neurological, probably related to lesions of the inferior hypogastric plexus and not to a lesion of the bladder. In this prospective study, there is no correlation between the preoperative disorders and the localisation of the lesions. A further study on a greater number of patients is necessary to define possible improvements and complications related to the surgery.