Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study
Objectives The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve‐sparing surgery for patients with endometriosis. Methods We analyzed 143 patients undergoing minimally invasive nerve‐sparin...
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| Veröffentlicht in: | Neurourology and urodynamics 2024-04, Vol.43 (4), p.862-873 |
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| creator | Gomes, Fernanda Hack Fonseca, Marlon de Freitas Favorito, Luciano Alves Gasparoni, Mauro Poggiali Silva Filho, Fernando Salles Diniz, André Luiz Lima Resende Júnior, José Anacleto D. |
| description | Objectives
The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve‐sparing surgery for patients with endometriosis.
Methods
We analyzed 143 patients undergoing minimally invasive nerve‐sparing surgery for endometriosis excision (laparoscopy/robot‐assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self‐reported 11‐point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p |
| doi_str_mv | 10.1002/nau.25414 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2967058373</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3040147618</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3134-156d98eb0108077917cfab7d4bc5994f37f81af854d8f114b3eb9baa3b88dbef3</originalsourceid><addsrcrecordid>eNp1kc1u1DAURi1ERYeBBS-ALLGBRVo7dmKH3WjET6WqbOjaspPr4sqxBzuZkh1vAM_Ik-BhWhZIrCxdn-_o6n4IvaDkjBJSnwc9n9UNp_wRWtGmJlUrhHiMVkQwVtW8Fafoac63hBDJePcEnTLJO9HUfIV-bL_ocAMZu4B9vIOE5-SCTgueku4nbOfQTy4GrO1UPkcX3Ki9Xwq_19ntAQdIe_j1_Wfe6ZK8wTYm3Mdx52ECDN96lw_xaDGEIY4wJRezy2_xpgxNLmF98GuP8zQPyzN0YrXP8Pz-XaPr9-8-bz9Wl58-XGw3l1XPKOMVbdqhk2AIJZII0VHRW23EwE3fdB23TFhJtZUNH6SllBsGpjNaMyPlYMCyNXp99O5S_DpDntTocg_e6wBxzqruWkEaycoF1-jVP-htnFPZOCtGOKFctFQW6s2R6lPMOYFVu1ROlRZFiTq0pEpL6k9LhX15b5zNCMNf8qGWApwfgTvnYfm_SV1tro_K38BvoDg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3040147618</pqid></control><display><type>article</type><title>Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study</title><source>Wiley Online Library - AutoHoldings Journals</source><creator>Gomes, Fernanda Hack ; Fonseca, Marlon de Freitas ; Favorito, Luciano Alves ; Gasparoni, Mauro Poggiali ; Silva Filho, Fernando Salles ; Diniz, André Luiz Lima ; Resende Júnior, José Anacleto D.</creator><creatorcontrib>Gomes, Fernanda Hack ; Fonseca, Marlon de Freitas ; Favorito, Luciano Alves ; Gasparoni, Mauro Poggiali ; Silva Filho, Fernando Salles ; Diniz, André Luiz Lima ; Resende Júnior, José Anacleto D.</creatorcontrib><description>Objectives
The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve‐sparing surgery for patients with endometriosis.
Methods
We analyzed 143 patients undergoing minimally invasive nerve‐sparing surgery for endometriosis excision (laparoscopy/robot‐assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self‐reported 11‐point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05).
Results
We observed significant improvements in LUTS after the surgery with postoperative symptom‐free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%.
Conclusion
The minimally invasive nerve‐sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.</description><identifier>ISSN: 0733-2467</identifier><identifier>EISSN: 1520-6777</identifier><identifier>DOI: 10.1002/nau.25414</identifier><identifier>PMID: 38497524</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Asymptomatic ; Endometriosis ; Laparoscopy ; lower urinary tract symptoms ; Magnetic resonance imaging ; minimally invasive surgical procedures ; Observational studies ; Pain ; Patients ; Statistical analysis ; Surgery ; Urinary tract ; urination disorders ; urodynamics ; Urogenital system</subject><ispartof>Neurourology and urodynamics, 2024-04, Vol.43 (4), p.862-873</ispartof><rights>2024 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3134-156d98eb0108077917cfab7d4bc5994f37f81af854d8f114b3eb9baa3b88dbef3</cites><orcidid>0000-0002-2710-2723 ; 0000-0003-2634-412X ; 0000-0001-7396-4351 ; 0000-0003-1562-6068 ; 0000-0002-0832-7572 ; 0000-0003-2514-6674 ; 0000-0001-8568-324X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fnau.25414$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fnau.25414$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38497524$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gomes, Fernanda Hack</creatorcontrib><creatorcontrib>Fonseca, Marlon de Freitas</creatorcontrib><creatorcontrib>Favorito, Luciano Alves</creatorcontrib><creatorcontrib>Gasparoni, Mauro Poggiali</creatorcontrib><creatorcontrib>Silva Filho, Fernando Salles</creatorcontrib><creatorcontrib>Diniz, André Luiz Lima</creatorcontrib><creatorcontrib>Resende Júnior, José Anacleto D.</creatorcontrib><title>Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study</title><title>Neurourology and urodynamics</title><addtitle>Neurourol Urodyn</addtitle><description>Objectives
The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve‐sparing surgery for patients with endometriosis.
Methods
We analyzed 143 patients undergoing minimally invasive nerve‐sparing surgery for endometriosis excision (laparoscopy/robot‐assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self‐reported 11‐point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05).
Results
We observed significant improvements in LUTS after the surgery with postoperative symptom‐free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%.
Conclusion
The minimally invasive nerve‐sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.</description><subject>Asymptomatic</subject><subject>Endometriosis</subject><subject>Laparoscopy</subject><subject>lower urinary tract symptoms</subject><subject>Magnetic resonance imaging</subject><subject>minimally invasive surgical procedures</subject><subject>Observational studies</subject><subject>Pain</subject><subject>Patients</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Urinary tract</subject><subject>urination disorders</subject><subject>urodynamics</subject><subject>Urogenital system</subject><issn>0733-2467</issn><issn>1520-6777</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp1kc1u1DAURi1ERYeBBS-ALLGBRVo7dmKH3WjET6WqbOjaspPr4sqxBzuZkh1vAM_Ik-BhWhZIrCxdn-_o6n4IvaDkjBJSnwc9n9UNp_wRWtGmJlUrhHiMVkQwVtW8Fafoac63hBDJePcEnTLJO9HUfIV-bL_ocAMZu4B9vIOE5-SCTgueku4nbOfQTy4GrO1UPkcX3Ki9Xwq_19ntAQdIe_j1_Wfe6ZK8wTYm3Mdx52ECDN96lw_xaDGEIY4wJRezy2_xpgxNLmF98GuP8zQPyzN0YrXP8Pz-XaPr9-8-bz9Wl58-XGw3l1XPKOMVbdqhk2AIJZII0VHRW23EwE3fdB23TFhJtZUNH6SllBsGpjNaMyPlYMCyNXp99O5S_DpDntTocg_e6wBxzqruWkEaycoF1-jVP-htnFPZOCtGOKFctFQW6s2R6lPMOYFVu1ROlRZFiTq0pEpL6k9LhX15b5zNCMNf8qGWApwfgTvnYfm_SV1tro_K38BvoDg</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Gomes, Fernanda Hack</creator><creator>Fonseca, Marlon de Freitas</creator><creator>Favorito, Luciano Alves</creator><creator>Gasparoni, Mauro Poggiali</creator><creator>Silva Filho, Fernando Salles</creator><creator>Diniz, André Luiz Lima</creator><creator>Resende Júnior, José Anacleto D.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2710-2723</orcidid><orcidid>https://orcid.org/0000-0003-2634-412X</orcidid><orcidid>https://orcid.org/0000-0001-7396-4351</orcidid><orcidid>https://orcid.org/0000-0003-1562-6068</orcidid><orcidid>https://orcid.org/0000-0002-0832-7572</orcidid><orcidid>https://orcid.org/0000-0003-2514-6674</orcidid><orcidid>https://orcid.org/0000-0001-8568-324X</orcidid></search><sort><creationdate>202404</creationdate><title>Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study</title><author>Gomes, Fernanda Hack ; Fonseca, Marlon de Freitas ; Favorito, Luciano Alves ; Gasparoni, Mauro Poggiali ; Silva Filho, Fernando Salles ; Diniz, André Luiz Lima ; Resende Júnior, José Anacleto D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3134-156d98eb0108077917cfab7d4bc5994f37f81af854d8f114b3eb9baa3b88dbef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Asymptomatic</topic><topic>Endometriosis</topic><topic>Laparoscopy</topic><topic>lower urinary tract symptoms</topic><topic>Magnetic resonance imaging</topic><topic>minimally invasive surgical procedures</topic><topic>Observational studies</topic><topic>Pain</topic><topic>Patients</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Urinary tract</topic><topic>urination disorders</topic><topic>urodynamics</topic><topic>Urogenital system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gomes, Fernanda Hack</creatorcontrib><creatorcontrib>Fonseca, Marlon de Freitas</creatorcontrib><creatorcontrib>Favorito, Luciano Alves</creatorcontrib><creatorcontrib>Gasparoni, Mauro Poggiali</creatorcontrib><creatorcontrib>Silva Filho, Fernando Salles</creatorcontrib><creatorcontrib>Diniz, André Luiz Lima</creatorcontrib><creatorcontrib>Resende Júnior, José Anacleto D.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neurourology and urodynamics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gomes, Fernanda Hack</au><au>Fonseca, Marlon de Freitas</au><au>Favorito, Luciano Alves</au><au>Gasparoni, Mauro Poggiali</au><au>Silva Filho, Fernando Salles</au><au>Diniz, André Luiz Lima</au><au>Resende Júnior, José Anacleto D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study</atitle><jtitle>Neurourology and urodynamics</jtitle><addtitle>Neurourol Urodyn</addtitle><date>2024-04</date><risdate>2024</risdate><volume>43</volume><issue>4</issue><spage>862</spage><epage>873</epage><pages>862-873</pages><issn>0733-2467</issn><eissn>1520-6777</eissn><abstract>Objectives
The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve‐sparing surgery for patients with endometriosis.
Methods
We analyzed 143 patients undergoing minimally invasive nerve‐sparing surgery for endometriosis excision (laparoscopy/robot‐assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self‐reported 11‐point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05).
Results
We observed significant improvements in LUTS after the surgery with postoperative symptom‐free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%.
Conclusion
The minimally invasive nerve‐sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38497524</pmid><doi>10.1002/nau.25414</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-2710-2723</orcidid><orcidid>https://orcid.org/0000-0003-2634-412X</orcidid><orcidid>https://orcid.org/0000-0001-7396-4351</orcidid><orcidid>https://orcid.org/0000-0003-1562-6068</orcidid><orcidid>https://orcid.org/0000-0002-0832-7572</orcidid><orcidid>https://orcid.org/0000-0003-2514-6674</orcidid><orcidid>https://orcid.org/0000-0001-8568-324X</orcidid></addata></record> |
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| language | eng |
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| source | Wiley Online Library - AutoHoldings Journals |
| subjects | Asymptomatic Endometriosis Laparoscopy lower urinary tract symptoms Magnetic resonance imaging minimally invasive surgical procedures Observational studies Pain Patients Statistical analysis Surgery Urinary tract urination disorders urodynamics Urogenital system |
| title | Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study |
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