Long-term urinary retention after laparoscopic surgery for deep endometriosis

Abstract

Objective: To report on chronic urinary retention after surgery for deep endometriosis and the possible risk factors for this complication.

Design: Descriptive study.

Setting: University hospital.

Patient(s): Four patients with deep endometriosis who developed this complication.

Intervention(s): Laparoscopic surgery, intermittent self-catheterization (ISC).

Main outcome measure(s): To identify site(s) of lesion associated with this complication.

Result(s): Four patients developed this complication from damage to the inferior hypogastric plexus involving the sympathetic and/or parasympathetic afferents from the bladder. One patient regained complete bladder function 8 months after surgery, and the others required ISC at the time of writing (13, 24, and 3 months after surgery). Patients with lesions located laterally and deep in the uterosacral ligaments especially near the ischial spines were at high risk. All patients were, however, satisfied with the results of surgery.

Conclusion(s): Most such injuries are unpredictable, but in our experience, two of three patients with lesions near the ischial spine developed this complication. Chronic urinary retention after radical endometriosis surgery is rare and often under reported. Although most lesions are unilateral and have a potential for improvement, it is not known how long these effects will last. More data from other centers may help in providing additional information.