Endometriosis and Vesico-Sphincteral Disorders

Abstract

ObjectivesThe aim of this mini review is to determine the relationship between endometriosis and urinary tract symptoms and to investigate the consequences of surgical treatment of mild to severe endometriosis, especially deep lesions, on the vesico-sphincteral function (lower urinary tract function).Materials and methodsWe performed a literature review by searching the MEDLINE database for articles published between 2000 and 2014, limiting the searches to the words: urinary tract, vesico-sphincteral, dysfunction, endometriosis, symptoms, and surgery.ResultsThe incidence of vesico-sphincteral symptoms in endometriosis varies from 3.4 up to 15.4%. The frequency of such symptoms seems to be under estimated because of a lack of specific questionnaire including urinary symptoms. Urodynamic evaluation could help to detect unsuspected abnormalities. It seems that endometriosis surgery (particularly deep infiltrating lesions) is a purveyor of de novo urinary dysfunction, with an incidence varying from 6.8 up to 17.5%. Nerve sparing processes such as neuro-navigators or neuro-stimulators seem to be promising techniques to avoid postoperative urinary tract dysfunction.ConclusionA precise anamnesis and the use of specific validated questionnaires (IPSS and BFLUTS) improve the screening of vesico-sphincteral symptoms in case of endometriosis. No recommendation can be found in the literature about the place of urodynamic evaluation. Most publications lack of proof and therefore do not allow making recommendations about optimal treatment of endometriotic lesions to avoid urinary tract disorders.

Role and Technique of Nerve-Sparing Surgery in Deep Endometriosis

“…Nevertheless,impactofDIEsurgeryonsexualfunctionis poorlyreportedinthemostimportantsurgicalseries(71)and datashowcontradictingresults.VandenBroecketalin2013 showedinaprospectivestudy,that63patientswhounderwentextensivesurgery(CO 2 laser)withbowelresectionfor moderateandsevereendometriosis,experiencedbetterorat leastsimilarimprovementsinsexualfunctioningthanthose whounderwentsurgerywithoutbowelresection (86).More recently,DiDonatoetal(87)foundasignificantimprovement betweenpre-andpost-surgicaltreatmentinthescoresofthe satisfaction scale, desire scale and pelvic problem interfer-encescaleofSexualHealthOutcomesinWomenQuestionnaire(SHOW-Q)in250patientswhounderwentlaparoscopic DIEexcision.Independentlytothepost-operativereduction in levels of dyspareunia, that undoubtedly influenced the otherdomainsofsexualfunctioning(desire,arousalandorgasm), and considering that appropriate assessment tools anddesignstudyaredifficulttosetup,laparoscopicDIEexcisionbyitself,seemstoamelioratethesexualfunction.Similar findingshavebeenreportedinseveralstudies (88)(89)(90),while earlierstatementsdescribedsexualdisturbancessuchasanorgasmia after low rectum resection due to damage of the autonomicnervesinfemalepatientswithrectalcancer (91). Moreover, a few studies had demonstrated significant presurgicalbladderdysfunctioninwomenaffectedbyposterior DIE (51,53,92,93), probably due to the neurotropism expressedbytheendometrioticcellsandthefibroticneuronal visceralinvasion (5,(94)(95)(96).However,theincidenceofvesicosphincteral symptoms in DIE seems to be under-estimated becauseofalackofuseofpre-surgicalspecificquestionnaire andurodynamicevaluation (97).…”

Pelvic floor muscle assessment on three‐ and four‐dimensional transperineal ultrasound in women with ovarian endometriosis with or without retroperitoneal infiltration: a step towards complete functional assessment

“…In addition to the classical pain syndrome of DIE (characterized by dysmenorrhea, dyspareunia, chronic pelvic pain, dysuria and dyschezia), deep lesions are associated with dysfunction of the pelvic organs and pelvic floor muscle (PFM). A series of events or combination of factors may contribute to the development of non‐relaxing PFM disorder in women with chronic pelvic pain, including direct or indirect (neuropathic) injury to the pelvic floor muscle, pelvic pain symptoms and inflammation.…”

Endometriosis and Infertility: The Impact on Quality of Life and Mental Health

“…The main clinical manifestations of endometriosis are peritoneal endometriosis, endometriotic ovarian cysts and deeply infiltrating endometriosis (DIE) (2). The latter is considered the most aggressive form of endometriosis, characterized by an infiltration of more than 5 mm (5, 6). DIE affects about 20% of women with endometriosis and causes pelvic pain and poor quality of life (6).…”