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Troubles fonctionnels après chirurgie de l’endométriose profonde

Functional sequelae after surgery of deep pelvic endometriosis

  • Mise au Point / Update
  • Published:
Pelvi-périnéologie

Résumé

Les troubles fonctionnels secondaires à la chirurgie de l’endométriose profonde (EP) sont essentiellement secondaires à des lésions du système nerveux végétatif pelvien (sympathique et parasympathique). Ces lésions sont soit secondaires à l’infiltration des fibres nerveuses par l’endométriose, soit secondaires à des traumatismes chirurgicaux. Elles sont responsables de troubles fonctionnels au niveau de la vessie, du rectosigmoïde et du vagin et se traduisent par des dysuries, une constipation terminale et une sécheresse vaginale. Leur fréquence est le plus souvent sousestimée, mais jusqu’à 30 % des patientes peuvent avoir des dysuries en postopératoire. Il faut savoir les rechercher par un interrogatoire dirigé ou à l’aide de questionnaires spécifiques. Le recours à des examens complémentaires est rarement nécessaire. Il convient essentiellement de prévenir les complications urinaires: infections ou détérioration du plancher pelvien par des efforts de poussée chronique. Leur évolution est le plus souvent favorable en quelques jours à quelques semaines. Pour les troubles vésicaux, nous recommandons les autosondages en première intention.

Abstract

Functional sequelae after surgery of deep pelvic endometriosis are both caused by surgical traumatism and/or infiltrating by the endometriotic lesions of the pelvic autonomic nerves. The consequences are bladder dysfunction, distal constipation, vaginal dryness and the decreased of vaginal sensitivity. The incidence of bladder dysfunctions are often underestimated, but nearly 30% of the patients described dysuria after surgical resection of deep infiltrating endometriosis. Postoperative assessments of these vegetative dysfunctions are important using validated questionnaire. Urodynamic or rectal investigations are usually not recommended. The main objective of the treatment is to avoid the complications of post-voiding residue like infection or deterioration of the peritoneal tissues by abdominal pushing. Self-catheterization should be recommended when these postoperative complication occur.

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Authors and Affiliations

  1. Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, F-69317, Lyon cedex 04, France

    C. Huissoud, P. de Saint-Hilaire, R. -C. Rudigoz & G. Dubernard

  2. Service de gynécologie-obstétrique, hôpital A.-Béclère, 157, rue de la Porte-de-Trivaux, F-92141, Clamart cedex, France

    X. Deffieux

  3. Service de gynécologie-obstétrique, hôpital Tenon, 4, rue de la Chine, F-75020, Paris, France

    E. Daraï

Authors
  1. C. Huissoud
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  2. X. Deffieux
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  3. P. de Saint-Hilaire
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  4. R. -C. Rudigoz
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  5. E. Daraï
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  6. G. Dubernard
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Correspondence to G. Dubernard.

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Huissoud, C., Deffieux, X., de Saint-Hilaire, P. et al. Troubles fonctionnels après chirurgie de l’endométriose profonde. Pelv Perineol 4, 270–277 (2009). https://doi.org/10.1007/s11608-009-0259-4

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  • DOI: https://doi.org/10.1007/s11608-009-0259-4

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