Urinary Complications After Surgery for Posterior Deep Infiltrating Endometriosis are Related to the Extent of Dissection and to Uterosacral Ligaments Resection

Abstract 

Surgery for deep infiltrating endometriosis can relieve symptoms and improve quality of life. However, few data are available on complications, especially urinary disorders. The aim of this longitudinal study (Canadian Task Force classification II-3) was to evaluate urinary complications of laparoscopic surgery for deep infiltrating endometriosis in 86 patients. The main locations of endometriosis were colorectum (58 patients), uterosacral ligaments (21 patients), and rectovaginal septum (7 patients). Patients requiring surgical resection for posterior deep pelvic endometriosis completed before and after surgery the Bristol Female Lower Urinary Tract Symptom Questionnaire. After surgery, almost all the patients reported significant urinary complications, consisting of hesitancy (p = .02), strain to start (p = .04), stopping flow (p = .01), incomplete emptying (p = .008), and reduced stream (p = .02). Most symptoms were observed postoperatively in the colorectum group. De novo hesitancy (p = .02), stopping flow (p = .02), and incomplete emptying (p = .004) occurred more frequently after colorectal resection than after resection of other locations. The risk of de novo urinary symptoms did not depend on uterosacral ligament resection, except for incomplete emptying (p = .003) when bilateral resection was performed. Extensive dissection in the colorectum group, when combined with uterosacral ligament resection, was associated with significant urinary complications. Urinary complications mainly occurred after segmental colorectal endometriosis resection combined with bilateral uterosacral ligament resection. Surgery designed to spare the pelvic autonomic nerves could reduce the incidence of urinary complications.