Dados do Trabalho

Título

EVALUATION OF PARAMETRECTOMY LEVELS IN DEEP ENDOMETRIOSIS SURGERY WITH A FOCUS ON URINARY RETENTION AND CLEAN INTERMITTENT CATHETERIZATION

Introdução e Objetivo

A endometriosis is a chronic and benign gynecological disease. Studies evaluating the consequences of different levels of pelvic nerve preservation during cytoreductive surgery on voiding function are scarce. This observational case series study anatomically classifies the different levels of nerve preservation of the inferior hypogastric plexus in parametrectomies and details the cases in which the bladder catheter was not removed the day after surgery with a focus on the risks of urinary retention and clean intermittent catheterization.

Método

 This series included 121 surgeries for deep endometriosis (laparoscopic and robotic) performed between August/2021 and February/2023 in Rio de Janeiro (Brazil). Parametrectomies were classified into 5 levels according to a percentage scale representing the level of nerve preservation: N5 [80 to 100%]; N4 [60 to 79%]; N3 [40 to 59%]; N2 [20 to 39%)]; N1 [0 to 19% preservation]. The criteria for non-definitive removal of the bladder catheter on the day following the first urination were: (criterion1) residual volume > 100mL; (criterion2) very extensive pelvic resections and partial cystectomies; (criterion3) parametrectomies with nerve preservation considered to have been "not ideal" in the surgeon's opinion. The 4 cases with outcomes considered "undesirable" were analyzed individually.

Resultados

The day after surgery, the bladder catheter was removed in 86 cases (residual volume <100mL), 22 cases remained with the catheter (residue > 100mL) and 13 cases remained with the catheter by order of the surgeon (criterion3). The 4 cases that evolved with the need for clean intermittent catheterization were analyzed separately. Post-voiding residues, clean intermittent catheterization times and nerve preservation levels (left/right) were, respectively: 750, 400, 1200 and 200mL; 25, 45, 60 and 120 days and N5/N3, N5/N3, N5/N3 and N2/N5. The estimated risks of developing the need for clean intermittent catheterization for more than 3 weeks (4 cases) and for more than 4 months (1 case) were 3.3% (95%CI: 0.8-6.6) and 0.8% (95%CI: 0.0-2.5).

Conclusão

The individual analysis of the cases raises the hypothesis that the N3/N2 groups  may evolve with a higher risk of urinary retention after surgery, since all the cases that evolved with the need for clean intermittent catheterization had their nerve preservation included in the N3/N2 groups.