Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery

Area of Science:

• Gynecology
• Urology
• Surgical Oncology

Background:

• Deep endometriosis surgery frequently necessitates collaboration with urological surgeons.
• Identifying factors predicting urological involvement is crucial for surgical planning.

Purpose of the Study:

• To determine pre-operative and intra-operative factors influencing the need for urological input in laparoscopic rectovaginal endometriosis resection.
• To evaluate a scoring system for predicting urological consultation requirements.

Main Methods:

• Retrospective cohort study of 230 patients undergoing laparoscopic deep endometriosis excision (London, UK, 2011-2015).
• Analysis of pre-operative, intra-operative, and post-operative data.
• Categorization of patients based on risk factors to assess the primary outcome: intra-operative urological surgeon input.

Main Results:

• Of 230 patients, 19.6% had hysterectomy, 14.8% required JJ stent placement, and 6.1% had bowel resections.
• In the normal-risk group (93.9%), 89.4% did not need urological input, but 10.6% required JJ stents, often with hysterectomy or bowel resection.
• Increased-risk patients (6%) had a high likelihood (78.6%) of requiring JJ stent insertion, with those having pre-operative renal dysfunction (36%) frequently needing ureteric reconstruction (80%).

Conclusions:

• Normal-risk patients without planned hysterectomy or bowel resection can be managed without specific urology input.
• Patients with identified risk factors are likely to need urological intervention, particularly for JJ stent placement.
• Pre-operative renal dysfunction indicates a high probability of intra-operative ureteric reconstruction, necessitating planned reconstructive urologist involvement.