Parametrial endometriosis and postoperative voiding dysfunction.

Parametrectomy accompanies surgical complications

Key Points

Highlights:

• The extent of the surgical resection for endometriosis is strongly associated with surgical complications.

Importance:

• The addition of parametrectomy for deep infiltrating endometriosis increases the rate of adverse postoperative events.

What's done here:

• This is a single-center retrospective cohort study by Benoit et al from a French tertiary hospital of Sorbonne University.
• A total of 753 patients with or without parametrectomy were compared in terms of demographic characteristics, indication for surgery, stage of endometriosis, route, and extent of surgery.
• Primarily the aim was to assess the impact of a parametrectomy on surgical outcomes. The secondary objective was to compare the predictive value of the selected surgery and postoperative complications.

Key results:

• 285 out of 753 women had a parametrial involvement of endometriosis. The left parametrium was more frequently involved.
• Overall 42 patients (7,2%) experienced intraoperative complications. Women with parametrectomy had a higher rate of postoperative complications, including voiding dysfunction.
• 17,5% of women with postoperative voiding dysfunction needed a self-catheterization for one month.
•  After multivariable analysis, the history of surgery, the surgical route, and the extent of the surgery were independently associated with postoperative complications.

Lay Summary

Parametrium constitutes a complex connective tissue containing blood vessels, the ureter, and the inferior hypogastric plexus, that extends from the lateral surface of the cervix and vagina to the lateral pelvic wall. Parametrial endometriosis may involve the vessels, nerves, and ureters in this compartment. Surgical removal of this space is not only difficult but also necessitates longer operating time and has intraoperative morbidity. Moreover, damage to the sympathetic and parasympathetic fibers will result in novel neurogenic postoperative pelvic organ dysfunctions.

Dr. Benoit et al. from the Department of Obstetrics and Reproductive Medicine of Tenon Hospital, Sorbonne University, Paris, France planned a single-center retrospective cohort study to compare the surgical complications rates of parametrectomy to other deep pelvic excision of endometriosis.

The study included 753 patients with deep pelvic endometriosis who had surgery over 5 years, 285 had parametrial invasion and underwent parametrectomy, torus, uterosacral ligament, and/or rectal resection. The control group was composed of  468 patients who also had pelvic surgery in the same period of time. The surgical indication was pain, infertility, or both while laparoscopy was the primarily preferred route.

The ASRM scores and the age of the women who underwent parametrectomy were higher than the controls, and 42% of the patients with parametrial involvement had a history of previous surgery. This could explain the slightly higher age in the parametrectomy cohort. Furthermore, parametrectomy group had higher ASRM scores and an increased risk of extensive surgery.

The authors concluded that the involvement of the parametrium is an independent factor of intra- and postoperative complications, including voiding dysfunction, and they recommended informing these patients pre-operatively about the risks and complications of the operation.

This study was recently published in the European Journal of Obstetrics and Gynecology.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35961258/