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Related Experiment Video

Updated: Nov 20, 2025

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity
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Predictive Factors for Voiding Dysfunction after Surgery for Deep Infiltrating Endometriosis.

Sara Imboden1, Yaelle Bollinger2, Kirsi Härmä2

  • 1Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)..

Journal of Minimally Invasive Gynecology
|January 21, 2021
PubMed
Summary

Postoperative voiding dysfunction after deep infiltrating endometriosis (DIE) surgery is common but usually temporary. Preoperative DIE nodules in ENZIAN compartment B, especially larger than 3 cm, predict higher risk.

Keywords:
Deep infiltrating endometriosisENZIAN classificationPostoperative urinary voiding dysfunctionSurgery

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Area of Science:

  • Gynecologic Surgery
  • Urology
  • Endometriosis Research

Background:

  • Deep infiltrating endometriosis (DIE) can cause significant morbidity.
  • Postoperative voiding dysfunction is a known complication following DIE surgery.
  • Predictive factors for this complication require further elucidation.

Purpose of the Study:

  • To identify pre- and perioperative factors prognostic for voiding dysfunction after DIE surgery.
  • To assess the incidence and duration of postoperative voiding dysfunction.

Main Methods:

  • Retrospective cohort study of 198 women with posterior compartment DIE.
  • Surgical resection of DIE nodules.
  • Postoperative bladder scans to assess voiding dysfunction (defined as >100 mL postvoid residual urine volume).

Main Results:

  • 41% of patients experienced initial postoperative voiding dysfunction, decreasing to 11% at discharge.
  • Voiding dysfunction resolved within a median of 41 days for those requiring self-catheterization.
  • Preoperative DIE in ENZIAN compartment B (p=.001) and lesion diameter >3 cm (HR 6.43, p<.001) were associated with dysfunction.
  • A first postvoid residual urine volume >220 mL predicted the need for self-catheterization (AUC 0.893, p<.001).

Conclusions:

  • Postoperative voiding dysfunction is frequent but typically temporary after DIE surgery.
  • Intraoperative identification of DIE in ENZIAN compartment B, particularly with lesions >3 cm, indicates an elevated risk.
  • Early identification of at-risk patients can guide management and counseling.