[Neurourological consequences of stress urinary incontinence and pelvic repair surgery].
It is difficult to prove the neurourological origin of a voiding disorder, pain or postoperative functional disorders after stress urinary incontinence and pelvic repair surgery and their incidence is difficult to evaluate. The purpose of this chapter is to review the data of the literature concerning complications of this type of surgery, possibly related to a neurological injury, regardless of the site. The most frequently encountered postoperative problem is acute urinary retention. Prevention of acute urinary retention must be based on preoperative assessment looking for risk factors and the quality of postoperative resumption of voiding after removal of the bladder catheter Medium-term and long-term de novo dysuria and/or urgency must be analysed according to a neurourological approach, looking for obstruction (that must be removed) and complications related to the implanted prosthetic material or to the operative technique. The most difficult symptom to assess is postoperative pelvic pain "induced" by surgery. It can be accentuated by a previously undiagnosed concomitant spinal or regional lesion (hip) and the diagnostic assessment must be based on a multidisciplinary approach. This review emphasizes the low level of proof of data of the literature in this field and supports the impression that prospective data from homogeneous cohorts must be recorded in registries, for example, despite the difficulty of long-term evaluation (> 5 years). In the future, patients in whom prosthetic material is implanted should probably be encouraged to more readily cooperate in this field to ensure continuing improvement of the quality of surgical care.
Chartier-Kastler
E
E
Service d'urologie, GH Pitié Salpétrière, Université Paris VI, France. emmanuel.chartier-kastler@psl.aphp.fr
Ayoub
N
N
Mozer
P
P
Richard
F
F
Ruffion
A
A
D006801:Humans; D010384:Pelvic Bones / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology*; D011391:Prolapse; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000517:prevention & control; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control; D016055:Urinary Retention / Q000209:etiology / Q000517:prevention & control; D014551:Urinary Tract / Q000294:innervation*; D014570:Urologic Diseases / Q000209:etiology* / Q000517:prevention & control