A narrative review of functional outcomes following nerve-sparing surgery for deeply infiltrating endometriosis

Abstract

Endometriosis negatively impacts the lives of countless women around the world. When medical management fails to improve the quality of life for women with either previously confirmed or suspected endometriosis often a decision must be made whether or not to proceed with surgery. When deeply infiltrating disease is diagnosed either clinically or by imaging studies often medical management alone will not suffice without excisional surgery. Surgery for endometriosis, especially deeply infiltrating disease, is not without risks. Aside from common risks of surgery endometriosis may also involve pelvic nerves, which can be hard to recognize to the untrained eye. Identification of pelvic nerves commonly encountered during endometriosis surgery is paramount to avoid inadvertent injury to optimize function outcomes. Injury to pelvic nerves can lead to urinary retention, constipation, sexual dysfunction, and refractory pain. However, nerve-sparing surgery for endometriosis has been proven to mitigate these complications and enhance recovery following surgery. Here we review the benefits of nerve-sparing surgery for deeply infiltrating disease.

Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis – a narrative review

“…We can identify the motor response of a tissue that is thought to be a nerve by applying bipolar current to it, so that connections with S3 produce flexion of the hallux and contractions of the pelvic floor, rectum, and bladder, while connections with S2 cause flexion of the other toes. Damages to the superior hypogastric nerves may lead to urinary retention, urinary hesitancy, constipation, urinary and fecal incontinence, and sexual dysfunction; inferior hypogastric plexus harm is often related to urinary retention, constipation, and sexual dysfunction; the injury of pelvic splanchnic nerves may also cause urinary retention ( 61 , 62 ). Mastering these concepts is essential for preventing bladder hypotonia or atony in the future, which is of utmost importance in urology.…”

Sacral Neuromodulation for defecation disorders after non oncologic pelvic surgery

“…It is known that endometriosis, especially deep one, can be the cause of chronic pelvic pain and defecation disorders that often force the patients to undergo surgical treatment [ 61 – 63 ]. However, these problems are not always solved by surgery and in some cases may even be worsened.…”