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Urinary Function after Surgery for Deep Endometriosis: A Prospective Study

  • Uri P. Dior
    Correspondence
    Corresponding author: Uri P. Dior, MD, MPH, Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
    Affiliations
    From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia

    Endometriosis Centre, Hadassah-Hebrew University Medical Centre (Drs. Levin and Dior), Jerusalem, Israel
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  • Charlotte Reddington
    Affiliations
    From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia
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  • Claudia Cheng
    Affiliations
    From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia

    Department of Obstetrics and Gynaecology, University of Melbourne (Drs. Cheng and Healey), Melbourne, Victoria, Australia
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  • Gabriel Levin
    Affiliations
    Endometriosis Centre, Hadassah-Hebrew University Medical Centre (Drs. Levin and Dior), Jerusalem, Israel
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  • Martin Healey
    Affiliations
    From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia

    Department of Obstetrics and Gynaecology, University of Melbourne (Drs. Cheng and Healey), Melbourne, Victoria, Australia
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Published:August 29, 2021DOI:https://doi.org/10.1016/j.jmig.2021.08.024

      ABSTRACT

      Study Objective

      To compare urinary function before and after surgery in patients undergoing laparoscopy for deep endometriosis and to measure the rate of postoperative deterioration in urinary function after surgery.

      Design

      Prospective questionnaire-based observational cohort study.

      Setting

      Tertiary university-affiliated hospital.

      Patients

      Included were 149 women who underwent surgery for deep endometriosis.

      Interventions

      Participants completed the international consultation on incontinence female lower urinary tract symptoms long-form questionnaire before surgery and 6 weeks, 6 months, and 12 months after surgery.

      Measurements and Main Results

      Bladder filling, voiding, and urinary incontinence summary scores were compared before and after surgery with mixed-effects linear regression analysis (correlated observations). Individual domains comprising the summary scores and their bother scores were also compared before and after surgery. Filling score at 6 weeks (3.7 ± 2.6), 6 months (3.2 ± 2.2), and 12 months (3.4 ± 2.2) improved from presurgery scores (4.2 ± 2.6) (p-value for the difference between before and after surgery: p <.001, p = .009, and p = .02 for 6 weeks, 6 months, and 12 months, respectively). No change was observed after surgery in bladder voiding score. Incontinence score improved at 6 weeks after surgery (presurgery and 6-week scores: 2.5 ± 3.3 and 1.6 ± 2.2, respectively, p <.001) but not thereafter. Patients with low preoperative summary scores had higher summary scores (worse function) after surgery, and patients with high preoperative scores had lower summary scores (improved function) after surgery.

      Conclusion

      Urinary function improved after laparoscopy for deep endometriosis. Greatest improvement was found in patients with worse preoperative function, whereas postoperative deterioration in urinary function was found for patients with initially normal function. More research is needed to better identify the subpopulations in whom surgical intervention provides symptomatic benefit or deterioration.

      Keywords

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