Séquelles vésicosphinctériennes, anorectales et génitosexuelles de l’hystérectomie View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-03

AUTHORS

L. Mamy, V. Letouzey, N. Chevalier, J. Gondry, P. Mares, R. de Tayrac

ABSTRACT

L’hystérectomie est la deuxième intervention la plus fréquente de la région abdominopelvienne en France, après la césarienne. Trois voies d’abord existent: la voie vaginale, la voie coelioscopique et la laparotomie. Les complications per-opératoires et le devenir des patientes à court terme ont bien été décrites. L’objectif de cet article est d’analyser les risques de séquelles vésicosphinctériennes, anorectales et génitosexuelles de l’hystérectomie à moyen et long terme. Cette mise au point est basée sur les données de la Cochrane Database et de Medline. Les mots clés utilisés ont été hysterectomy, urinary incontinence, constipation, dyspareunia, et sequelae. La période couverte va de 1985 à 2008. Ne sont pas pris en compte dans cette analyse les risques de prolapsus secondaire et les hystérectomies pour pathologie maligne (10 % des hystérectomies). Les séquelles vésicosphinctériennes existent, et l’hystérectomie expose à un risque d’incontinence urinaire à long terme. Concernant les séquelles anorectales, les données de la littérature sont plus contradictoires. Elles sont probablement minimes. Quant aux conséquences génitosexuelles, l’association à une annexectomie bilatérale chez des patientes non ménopausées peut entraîner une difficulté d’adaptation à la carence hormonale, comme en début deménopause. La voie d’abord de l’hystérectomie pour pathologie bénigne pourrait avoir un retentissement psychosexuel, au bénéfice des voies coelioscopique et vaginale. Il n’y a pas d’intérêt en la conservation du col utérin. L’hystérectomie, quelle que soit sa voie d’abord, entraîne des risques de séquelles sur le long terme, en particulier, urinaires et psychosexuelles. Les voies d’abord vaginale et coelioscopique sont à privilégier par rapport à la laparotomie. Il n’y a pas d’intérêt à la conservation du col utérin. Un nouveau débat est ouvert sur la préservation de l’utérus chez les jeunes femmes en chirurgie du prolapsus. Toutefois, des recherches approfondies sont nécessaires, en particulier sur le long terme, par de larges essais randomisés visant à réduire aumaximum les biais. D’autres recherches sont également nécessaires pour définir le rôle des nouvelles approches de l’hystérectomie telles que l’hystérectomie totale par laparoscopie. More... »

PAGES

22-30

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11608-009-0222-4

DOI

http://dx.doi.org/10.1007/s11608-009-0222-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1003738398


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