Clinical opinionUrinary Complications After Surgery for Posterior Deep Infiltrating Endometriosis are Related to the Extent of Dissection and to Uterosacral Ligaments Resection
Section snippets
Patients
From April 2001 through April 2004, 90 women with DIE were referred to our gynecology department.
Before surgery, all women underwent both transvaginal sonography and magnetic resonance imaging to confirm the topography of endometriosis. All the patients received gonadotropin-releasing hormone analogs for 3 months before surgery. The main location of endometriosis was the colorectum in 58 patients (67.4%) (colorectum group) (data previously published [7]), uterosacral ligaments in 21 patients
Surgical Findings
Of the 86 patients, 79 (91.9%) underwent surgical resection of endometriotic lesions by laparoscopy, exclusively. Seven patients (8.1%) (all in the colorectum group) required conversion to open surgery. The reasons for laparoconversion were severe adhesions related to endometriosis in 4 cases, incomplete circular stapled anastomosis at the end of the laparoscopic procedure in 1 case, ureteral involvement by endometriosis requiring segmental ureterectomy with reimplantation into the bladder in 1
Discussion
This study confirms the high incidence of de novo urinary symptoms after surgery for posterior DIE. De novo urinary symptoms were more frequent after colorectal resection than after resection of other sites. The extent of resection appeared the main determinant of urinary complications.
The overall incidence of de novo urinary symptoms was 30% in this study. This high incidence may be explained by systematic preoperative and postoperative evaluations of urinary symptoms with a validated
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