The impact of total laparoscopic excision of deep endometriosis (DE) on bladder and bowel dysfunction: a prospective...

Deep endometriosis (DE) is established to cause chronic pelvic pain (CPP), lower urinary tract symptoms (LUTS) and altered bowel function. Although the aim of surgical excision is often to relieve CPP, evidence suggests it could also affect LUTS and bowel symptoms, especially where DE affects the bowel or urinary tract. We assessed the prevalence and improvements in CPP, LUTS and bowel symptoms in 130 patients preoperatively and 6 months following total excision of endometriosis using the British Society for Gynaecological Endoscopy (BSGE) Pelvic Pain Questionnaire. Pain symptoms and LUTS are graded 0-10 whilst bowel function is scored 0-4, each using Likert scales. Patients with urinary tract DE reported median bladder pain and bladder voiding dysfunction of 7/10 (95 % CI: 3-8) and 7/10 (95 % CI: 0-9), respectively. Improvements at follow-up did not reach statistical significance at the Šidák-adjusted significance threshold, although 80.0 % and 60.0 % of patients reported clinically important improvements to these respective symptoms. There were also no cases of de novo LUTS following excision of urinary tract DE. Patients with bowel DE reported CPP and menstrual dyschezia of 7/10 (95 % CI: 6-8) and 8/10 (95 % CI: 4-8), respectively. Although a significant proportion of patients with bowel DE reported clinically important improvements in bowel symptoms, the difference in symptomatic severity failed to reach statistical significance. Whilst excision of DE can produce clinically important improvements in LUTS and bowel symptoms in a large proportion of patients, there is also a considerable risk of occasioning de novo bowel symptoms.