title: Pathophysiologic explanation for bladder retention in patients after laparoscopic surgery for deeply infiltrating rectovaginal and/or parametric endometriosis.
abstract: OBJECTIVE
  To investigate pathophysiologic mechanisms involved in bladder retention after surgery for rectovaginal deeply infiltrating endometriosis (DIE).
  
  
  METHODS
  Retrospective case study.
  
  
  METHODS
  Tertiary referral unit.
  
  
  METHODS
  All patients who presented at our center over the last 5 years with bladder retention developed after laparoscopic surgery for rectovaginal or parametric DIE.
  
  
  METHODS
  To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step workup including patient history, clinical neuropelveologic assessment, cystoscopy, and video-urodynamic testing with pelvic floor electromyography and rectomanometry.
  
  
  METHODS
  Patient Perception of Bladder Condition, International Prostate Symptom Score, and the short-form version of the Urogenital Distress Inventory questionnaires.
  
  
  RESULTS
  Forty-seven patients were investigated in this study. Mean (±SD) interval from the surgery was 9.5 years (±4.3; range, 7-15 years). Eighteen patients developed acute paralytic motor bladder atony and 5 acute neurogenic bladder atony. Twenty-four patients developed chronic neurogenic bladder atony. The first symptom of chronic bladder retention was reduction of urinary frequency (after 5 years on average). The most frequent complaints that made patients aware of difficulties in voiding were a weak urinary stream (appearing on average 7 years after the procedure) and the need for Valsalva or Crede maneuver (on average 9 years after the procedure).
  
  
  CONCLUSIONS
  Segmental rectum resection with parametric resection exposes the most patients to the risk of bladder motor paralytic retention. However, the most frequent etiology seems to be chronic myogenic destruction secondary to chronic bladder overdistention. Patients after surgery for DIE require a long follow-up, with particular attention paid to postvoid residual volumes.
authors.affiliation: Possover International Medical Center, Hirslanden Clinic, Zürich, Switzerland; and Department of Gynecology and Obstetrics, University of Aarhus, Aarhus, Denmark. Electronic address: m.possover@isnp-gmbh.com.
authors.forename: Marc
authors.initials: M
authors.lastname: Possover
mesh_terms: D004715:Endometriosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000639:trends; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D016055:Urinary Retention / Q000175:diagnosis / Q000453:epidemiology*; D014621:Vagina / Q000473:pathology / Q000601:surgery*
keywords: Deep endometriosis; bladder function; bladder retention; neuropelveology; pelvic nerves