Troubles urinaires associés au traitement chirurgical de l’endométriose profonde: intérêt de la chirurgie avec préservation nerveuse
Tóm tắt
Après exérèse chirurgicale des lésions d’endométriose profonde (ligmanet[s] utérosacré[s] ou lors d’une résection rectale), les troubles urinaires de novo peuvent affecter jusqu’à 30 % des patientes avec une altération de la vidange vésicale. Ces troubles urinaires sont dus à des lésions des branches nerveuses des plexus hypogastriques inférieurs, lésions qui peuvent être uniou bilatérales. En pré-opératoire, les patientes doivent être informées de ce risque potentiel. La chirurgie avec préservation nerveuse permet de réduire de façon significative la survenue de ces troubles urinaires. En postopératoire, quand le résidu postmictionnel est supérieur à 100 ml et afin de prévenir le risque de complications, la réalisation d’autosondages est recommandée. L’évolution est le plus souvent favorable après quelques jours d’autosondages. Le recours à des épreuves urodynamiques et à des explorations électrophysiologiques s’avère nécessaire uniquement en cas de persistance des troubles urinaires.
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