Impact of deep resection of endometriosis in the pelvis on urodynamic parameters

Farias, Jardel Cavalcante de; Nascimento, Maria do Desterro Soares Brandão; Leal, Plínio da Cunha; Oliveira, Caio Márcio Barros de; Moura, Ed Carlos Rey

doi:10.1590/acb386323

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Acta Cirúrgica Brasileira

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Sumário

Clinical Investigation • Acta Bras Cir 38 • 2023 • https://doi.org/10.1590/acb386323 copy

Impact of deep resection of endometriosis in the pelvis on urodynamic parameters

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To evaluate the effects of deep resection of endometriosis in the posterior pelvic region on urodynamic parameters.

Methods:

A prospective observational study conducted with female patients diagnosed with deep pelvic endometriosis before and after endometriosis resection surgery. Clinical history, image exams, the Female Lower Urinary Tract Symptoms questionnaire, urodynamic examination, cystometry, and voiding study were evaluated.

Results:

Patients aged 30–39 years old, operative duration of 132.5 minutes, and 2.7 days of hospital stay. Uroflowmetry and cystometry showed tendency for an increase after the surgery in the flow duration, time to maximum flow, and first voiding desire and decreased residual volume and maximum cystometric capacity. Opening, maximum urinary flow, and maximum flow pressure decreased at T1, and the closing parameters increased, although statistically non significant. The variables decreased at T1 in the urodynamic, except for detrusor overactivity. Although we observed a reasonable number of low bladder compliance and abnormal bladder sensation, the results were maintained at T1. General scores for filling and incontinence showed a significant decrease after surgery.

Conclusions:

A significant response in the patient’s perception of urinary function was demonstrated after surgery. It is observed that the surgical procedure did not affect the uroflowmetric and cystometric characteristics of the evaluated patients.

Key words
Endometriosis; Laparoscopy; Urogenital System; Urodynamics; Quality of Life

Variables		n (%)
	Total	33 (100)
Age (years old)
	20–29	3 (9.1)
	30–39	16 (48.5)
	40–48	14 (42.4)
	MD±DP	37.0±7.4
Number of Children
	0	20 (60.6)
	1	6 (18.2)
	2	3 (9.1)
	3	4 (12.1)
	BMI	23.8±2.6
Dysmenorrhea
	Yes	33 (100)
	No	0 (0)
	VAS Dysmenorrhea	8.5±1.1
Dyspareunia
	Yes	24 (72.7)
	No	9 (27.3)
VAS Dyspareunia		8.8±0.6
Surgery time (min)		132.5±54.7
Length of stay (days)		2.7±1
Surgical complications
	No	33 (100)
Surgical reapproach
	No	33 (100)
Previous gynecological surgeries
	None	23 (69.7)
	Cesarean	6 (18.2)
	Oophorectomy	1 (3)
	Oophoroplasty	2 (6.1)
	Salpingectomy	1 (3)
Surgical complications
	No	33 (100)
Surgical reapproach
	No	33 (100)

Variables		T0	T1	p-value
		Med	Med
		(min–max)^* * median (minimum–maximum);	(min–max)^* * median (minimum–maximum);
Uroflowmetry
	Flow duration(s) (MD±SD)	62.7±24.8	67.9±24.6	0.429 §
	Time to maximum flow(s)	16 (8–68)	20 (7–69)	0.507 £
	Maximum flow (mL)	16 (5–27)	15 (7–42)	0.800 £
	Average flow (mL)	8 (4–15)	8 (4–15)	0.481 £
	Urinary volume (mL) (MD±SD)	421.9±119.5	420.1±91.2	0.936 §
Cystometry
	First desire to void (mL)	128 (40–300)	170 (40–380)	0.137 £
	Residual volume (mL)	30 (0–230)	10 (0–175)	0.066 £
	MC² (mL) (Md±DP)	475.9±110	458.4±83.3	0.344 §

Pressure study	T0	T1	p-value
Pressure study	Med (min–max)^* * median (minimum–maximum);	Med (min–max)^* * median (minimum–maximum);	p-value
Closing (cmH2O)	28 (4–70)	31 (0–55)	0.712 £
MCC (cmH2O)	15 (1–30)	15 (6–44)	0.917 £
Opening (cmH2O) (MD±DP)	22.7±13.4	18.9±10	0.188 §
Maximum urinary flow (cmH2O) (MD±DP)	39.1±14.6	34.6±9.1	0.100 §
Maximum flow (cmH2O) (MD±DP)	39.4±17.7	34.7±12	0.218 §

Urodynamic observations	T0	T1	p-value ^€ € McNemar. Source: Elaborated by the authors.
Urodynamic observations	n (%)	n (%)	p-value ^€ € McNemar. Source: Elaborated by the authors.
Low bladder compliance^a a Bladder compliance (urine volume + residual volume ÷ maximum cystometric capacity) < 30 mL/cmH2O;	15 (45.5)	19 (57.6)	1.000
Abnormal bladder sensation^b b first desire to void occurs in cystometry < 80 or > 200 mL;	12 (36.4)	8 (24.2)	0.687
Detrusor hyperactivity^c c involuntary detrusor contractions during the filling phase;	0 (0)	0 (0)	Na
Abnormal residual urine^d d post-voiding residue > 100 mL;	8 (24.2)	4 (12.1)	0.727
Low maximum cystometric capacity^e e maximum cystometric capacity < 300 mL; Na: absence of 2x2 crossing to perform the test; T0: preoperative; T1: postoperative;	2 (6.1)	1 (3)	0.500

Score ICIQ-FLUTS	T0	T1	p-value £
	Med	Med
	(min–max)^* * Median (minimum–maximum); T0: preoperative; T1: postoperative; £ Wilcoxon. Source: Elaborated by the authors.	(min-max)^* * Median (minimum–maximum); T0: preoperative; T1: postoperative; £ Wilcoxon. Source: Elaborated by the authors.
Filling (Score F)	6 (1–16)	2 (0–9)	< 0.001
Nocturia	2 (0–4)	1 (0–4)	0.034
Urgency	0 (0–4)	0 (0–2)	0.004
Bladder pain	2 (0–4)	0 (0–4)	< 0.001
Frequency	1 (0–5)	0 (0–3)	0.002
Voiding (Score V)	1 (0–12)	0 (0–10)	0.077
Hesitation	0 (0–4)	0 (0–2)	0.020
Stress	0 (0–4)	0 (0–4)	0.168
Intermittency	0 (0–4)	0 (0–4)	0.037
Incontinence (Score I)	1 (0–11)	0 (0–4)	0.002
Urge Incontinence	0 (0–3)	0 (0–2)	0.014
Frequency of urinary incontinence	0 (0–4)	0 (0–2)	0.010
Stress urinary incontinence	0 (0–3)	0 (0–2)	0.010
Unexplained urinary incontinence	0 (0–3)	0 (0–1)	0.021
Nocturnal enuresis	0 (0–2)	0 (0–2)	0.564

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[1] *Corresponding author: jardelfarias.go@gmail.com