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. 2024 Dec;310(6):3267-3278.
doi: 10.1007/s00404-024-07842-2. Epub 2024 Nov 28.

Unilateral nerve preservation during parametrectomy is not sufficient to prevent persistent urinary retention after cytoreductive endometriosis surgery

Mauro Poggiali Gasparoni Jr  1   2 , Marlon de Freitas Fonseca  3   4 , Luciano Alves Favorito  5   6   7 , Fernando Salles da Silva Filho  5   8 , Andre Luiz Lima Diniz  5   8 , Mathias Ferreira Schuh  5   8 , Fernanda Hack Gomes  5   8 , José Anacleto Dutra de Resende Jr  5   6   4
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Unilateral nerve preservation during parametrectomy is not sufficient to prevent persistent urinary retention after cytoreductive endometriosis surgery

Mauro Poggiali Gasparoni Jr et al. Arch Gynecol Obstet. 2024 Dec.

Abstract

Objectives: This study sought to quantify the risks of urinary retention following different levels or degrees of nerve preservation during parametrectomies for deep endometriosis (DE).

Methods: Women undergoing laparoscopic and robotic nerve-sparing DE surgeries were studied. The cases were divided into 6 groups according to the degree of preservation of parasympathetic parametrium fibers on each side: P1 (P1 left /P1 right-Excellent preservation: presacral and pararectal fascia bilateral preservation), P2 (P1/P2 or P2/P1, P2/P2-Regular preservation: fascia violation with local fat visualization-either of both sides; and P3 (P1/P3 or P3/P1, P2/P3 or P3/P2, P3/P3)-Poor preservation: musculature and pelvic floor exposure-even if only unilateral.

Results: Of a total of 151 women eligible for the study, 110 (72.8%) had excellent nerve preservation; 24 (15.8%) had regular nerve preservation, and 17 (11.2%) had poor-nerve preservation. The incidence of elevated PVR was higher in the P3 group. Thirty-five patients were catheterized post-operatively, more common in the P3 group. In four cases from the P3 group, prolonged intermittent self-catheterization after discharge was necessary. The calculated risk of needing intermittent catheterization in the P3 group was 23.1% up to 8 weeks and 7.7% up to 8 months post-surgery.

Conclusion: Parametrectomy with poor-nerve preservation can lead to urinary retention, even with excellent contralateral preservation.

Keywords: Endometriosis; Hypogastric plexus; Intermittent urethral catheterization; Laparoscopy; Urinary retention.

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Conflict of interest statement

Declarations. Conflict of interest: None declared. None of the authors have any competing interest that could be perceived to bias this work. In the same way, there was no influence of any of the financial support in the results presented. Ethical approval: The study was approved according to the ethical standards of the hospital’s institutional committee on experimentation with human beings [CAAE 31050120.2.0000.5259]. The study has also been registered in the Brazil Platform, maintained by the National Research Ethics Commission for Studies with Human Subjects, a commission of the National Health Council of the federal Ministry of Health. We affirm that all methods used in this study were carried out in accordance with relevant guidelines and regulation in compliance with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Consent to participate: Informed consent was obtained from all individual participants included in the study.

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