Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease

Júnior, José Anacleto Dutra de Resende; Crispi, C.P.; Cardeman, Leon; Buere, Renata Teles; Fonseca, Márlon de Freitas

doi:10.1007/s00192-017-3531-0

Cited by 27 publications

(22 citation statements)

References 21 publications

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“…Symptoms can be nonspecific, and the physical examination is frequently inaccurate. Endometriosis involving the bladder can disturb storage function, while endometriosis involving the parametrium impairs the voiding phase [ 2 ]. Therefore, we believe that the inclusion of urodynamic studies and defecography in the preoperative evaluation should be considered when major surgery for the treatment of endometriosis is planned.…”

Section: Discussionmentioning

confidence: 99%

“…Although the patient denied urinary symptoms, considerable involvement of the anterior and lateral compartments was identified by the MRI. Therefore, a more complete assessment of lower urinary tract anatomy and function was also performed preoperatively because of the possibility of subclinical abnormalities in micturition [ 2 ]. Cystoscopy revealed a normal bladder without endometriosis but detected thickening and retraction of the round ligaments bilaterally.…”

Section: Preoperative Assessment Of Pelvismentioning

confidence: 99%

“…Endometriosis is a remarkably frequent condition that affects women's health-related quality of life (HRQoL) [ 1 ]. Besides pain, infertility, and sexual dysfunction, endometriosis is also associated with bowel and lower urinary tract dysfunctions [ 2 – 4 ]. Cytoreductive surgery is the current treatment of choice to improve health-related quality of life in cases in which improvement with medical management has been unsatisfactory [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Before undertaking surgery—increasingly performed using minimally invasive techniques—our team recommends a thorough preoperative assessment of pelvic function. The two studies we recommend are urodynamics [ 2 ] and dynamic magnetic resonance defecography (DMRD)—a special type of MRI, in which sequential images are obtained at various stages of defecation [ 9 ]. Here, we report the case of a young woman who underwent laparoscopic nerve-sparing surgery for deep infiltrating endometriosis (DIE) in a private practice setting, which included segmental colorectal resection.…”

Section: Introductionmentioning

confidence: 99%

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Five-Month Follow-Up Assessing Defecography and Urodynamics after Laparoscopic Nerve-Sparing Colorectal Resection for Endometriosis

Crispi¹,

Salomão

Joaquim³

et al. 2020

Case Reports in Obstetrics and Gynecology

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Introduction. Large resections may be necessary in cytoreductive surgery for endometriosis, which present risk of urinary and bowel complications. Presentation of Case. A 29-year-old woman underwent multidisciplinary laparoscopy for endometriosis in a private practice setting for acyclic pelvic pain and cyclic abdominal distension with changes in bowel habits and frequent sensation of incomplete defecation. After surgery, urodynamics remained normal and bowel function improved subjectively and objectively per dynamic magnetic resonance defecography (DMRD). The five-month follow-up found improvements in pain scores, bowel function, and health-related quality of life (assessed by the full versions of the Short Form 36 and Endometriosis Health Profile 30 scales). Discussion. Animus may contribute to the bowel symptoms in women with endometriosis. DMRD provides additional objective parameters for comparing pre- and postoperative functions. Conclusion. A nerve-sparing segmental rectosigmoidectomy for endometriosis carefully executed by a multidisciplinary team can preserve the function of different pelvic organs.

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Section: Discussionmentioning

confidence: 99%

Section: Preoperative Assessment Of Pelvismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Five-Month Follow-Up Assessing Defecography and Urodynamics after Laparoscopic Nerve-Sparing Colorectal Resection for Endometriosis

Crispi¹,

Salomão

Joaquim³

et al. 2020

Case Reports in Obstetrics and Gynecology

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“…Dysmenorrhea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms, and they may occur independently or in combinations . Besides pain, infertility, sexual disorders and lower urinary tract dysfunction, endometriosis is also associated with mental health problems, some of which correlate with the severity and chronicity of the pelvic pain . Endometriosis is one of the principal causes of chronic pelvic pain in young women.…”

Section: Introductionmentioning

confidence: 99%

Endometriosis infiltrating the pelvic floor muscles with histopathological correlation—A case report

Crispi¹,

Crispi²,

Cardeman

et al. 2019

J of Obstet and Gynaecol

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We report the case of a 29‐year‐old woman with deep infiltrating endometriosis who underwent robotic nerve‐sparing surgery for resection of all visible lesions infiltrating pelvic and extrapelvic sites. Painful symptoms included severe dysmenorrhea, menstrual dyschezia and stranguria, with no improvement in response to hormonal treatment. The location on physical examination of a painful retrocervical nodule was identified by magnetic resonance imaging to be infiltrating the right parametrium/paracervix. During surgery, this nodule was recognized as an important retrocervical/rectovaginal lesion infiltrating the pelvic floor (i.e. levator ani and coccygeus), and was histopathologically confirmed as endometriosis infiltrating the skeletal pelvic floor muscles. A Pubmed search of the MEDLINE database in March (2019) found no publication reporting histopathologic confirmation of endometriosis infiltrating the pelvic floor muscles.

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Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study

Gomes,

Fonseca,

Favorito

et al. 2024

Neurourology and Urodynamics

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ObjectivesThe objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve‐sparing surgery for patients with endometriosis.MethodsWe analyzed 143 patients undergoing minimally invasive nerve‐sparing surgery for endometriosis excision (laparoscopy/robot‐assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self‐reported 11‐point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05).ResultsWe observed significant improvements in LUTS after the surgery with postoperative symptom‐free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%.ConclusionThe minimally invasive nerve‐sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.

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Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease

Abstract: Our findings strongly suggest that endometriosis involving the bladder might disturb storage function, whereas endometriosis in the parametrium disturbs the voiding phase.

Cited by 27 publications

References 21 publications

Five-Month Follow-Up Assessing Defecography and Urodynamics after Laparoscopic Nerve-Sparing Colorectal Resection for Endometriosis

Five-Month Follow-Up Assessing Defecography and Urodynamics after Laparoscopic Nerve-Sparing Colorectal Resection for Endometriosis

Endometriosis infiltrating the pelvic floor muscles with histopathological correlation—A case report

Changes in lower urinary tract function after minimally invasive nerve‐sparing for complete excision of endometriosis: An observational study

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