Urogynecological Outcomes After Minimally Invasive Surgery for Deep Endometriosis: A Systematic Review

Area of Science:

• Gynecology
• Urology
• Surgical Outcomes

Background:

• Deep endometriosis (DE) frequently impacts pelvic organs and can cause lower urinary tract symptoms (LUTS).
• The effect of minimally invasive surgery (MIS) for DE on postoperative urinary function is not well-established.
• Nerve disruption during surgery can further complicate urinary function postoperatively.

Purpose of the Study:

• To systematically review postoperative urogynecological outcomes after laparoscopic or robotic surgery for DE.
• To evaluate the impact of MIS on lower urinary tract symptoms (LUTS) in women with deep endometriosis.
• To identify factors influencing urinary function outcomes following DE excision.

Main Methods:

• Systematic review of PubMed, Scopus, and Cochrane Library for studies over the last 25 years.
• Inclusion of studies assessing postoperative urinary outcomes via validated questionnaires or urodynamic testing in women undergoing MIS for DE.
• Quality appraisal using the Newcastle-Ottawa Scale.

Main Results:

• Nine studies (20-289 participants) met inclusion criteria.
• Six studies reported significant improvements in urgency, frequency, and dysuria, particularly in women with moderate-to-severe preoperative LUTS.
• Three studies noted no change or worsening of urinary function, especially in those with minimal baseline symptoms or extensive nerve involvement.

Conclusions:

• Minimally invasive surgery for DE may offer symptomatic relief for LUTS in selected patients, especially with nerve-sparing approaches.
• Functional deterioration is a risk, particularly for patients with minimal baseline LUTS or extensive nerve involvement.
• Further research with standardized measures and prospective trials is needed to optimize patient selection and surgical techniques.