目的:评估深度子宫内膜异位症术后膀胱功能障碍需要间歇性自我导尿的患者恢复膀胱正常排尿功能所需的时间,并确定可能影响恢复过程的风险因素。
方法:回顾性研究基于大型前瞻性数据库中记录的数据。
方法:子宫内膜异位症转诊中心。
方法:从2018年9月至2022年6月,1,900例患者在我们中心接受了深部子宫内膜异位症切除术。61例患者出院,建议进行间歇性自我导管插入,因此被纳入研究。
方法:子宫内膜异位症手术后间歇性自我导尿。
结果:43例患者(70.5%)在随访期间停止自我导尿。中位随访时间为25周(范围,7至223周)。腹腔镜手术48例(78.7%),机器人手术13例(21.3%)。47例患者(77%)有累及消化道的结节,11人(18%)有泌尿道受累,29例子宫旁结节(47.5%),13例(21.3%)累及骶丛。膀胱排尿功能恢复和自行导尿停止的概率为24.5%,54%,59%,72%,在第4、8、12、52和78周分别为77%。Cox的多变量模型确定术前膀胱功能障碍是自我导尿停止的唯一具有统计学意义的独立预测因素(HR0.36,95CI0.15-0.83)。
结论:深度子宫内膜异位症切除术后需要间歇性自我导尿治疗膀胱功能障碍的患者在77%的病例中可以自发恢复膀胱功能。提示术前膀胱排尿功能障碍的症状应在计划手术前进行检查,应告知患者术后长期膀胱排尿功能障碍的风险较高。
OBJECTIVE: To assess the duration needed for regaining normal bladder voiding function in patients with postoperative bladder dysfunction requiring intermittent self-catheterization after deep endometriosis surgery and identify risk factors that might affect the recovery process.
METHODS: Retrospective study based on data recorded in a large prospective database.
METHODS: Endometriosis referral center.
METHODS: From September 2018 to June 2022, 1900 patients underwent excision of deep endometriosis in our center; 61 patients were discharged with recommendation for intermittent self-catheterization and were thus included in the study.
METHODS: Intermittent self-catheterization after endometriosis surgery.
RESULTS: A total of 43 patients (70.5%) stopped self-catheterization during the follow-up period. Median follow-up was 25 weeks (range, 7-223 wk). Surgery was performed laparoscopically in 48 patients (78.7%) and robotically in 13 (21.3%); 47 patients (77%) had nodules involving the digestive tract, 11 (18%) had urinary tract involvement, 29 had parametrial nodules (47.5%), and 13 (21.3%) had sacral plexus involvement. The probability of bladder voiding function recovery and arrest of self-catheterization was 24.5%, 54%, 59%, 72%, and 77% at 4, 8, 12, 52, and 78 weeks, respectively. Cox\'s multivariate model identified preoperative bladder dysfunction as the only statistically significant independent predictor for arrest of self-catheterization (hazard ratio, 0.36; 95% confidence interval, 0.15-0.83).
CONCLUSIONS: Patients requiring intermittent self-catheterization for bladder dysfunction after deep endometriosis excision may spontaneously recover bladder function in 77% of cases. Symptoms suggesting preoperative bladder voiding dysfunction should be reviewed before planning surgery, and patients should be informed of the higher postoperative risk of long-term bladder voiding dysfunction.