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Voiding Dysfunction After Robotic-Assisted Laparoscopic Surgery for Colorectal Endometriosis: A Systemactic Review
Alexandra Madar1, Clément Ferrier1, Yohan Dabi1
1Department of Gynecology and Obstetrics, Medicine of the Reproduction, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France (all authors).
Objective:
To evaluate the incidence of voiding dysfunction (VD) after surgery for deep infiltrating endometriosis with colorectal involvement and compare outcomes between conventional laparoscopy (CL) and robotic-assisted laparoscopic surgery (RALS).
Data Sources:
A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Embase, the Cochrane Library, and Web of Science.
Methods Of Study Selection:
Eligible studies included prospective, retrospective, or randomized trials reporting VD after RALS for colorectal endometriosis. VD was defined according to reported criteria, including need for intermittent self-catheterization, subjective dysuria, or a postoperative residual bladder volume of >100 mL. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 statistic.
Tabulation, Integration, And Results:
Eleven studies met the inclusion criteria for the qualitative synthesis and 10 for the meta-analysis, comprising 728 patients (225 CL; 503 RALS). Overall, VD was observed in 52 patients (7.1%). VD was less frequent after RALS than CL (4.4% vs 13.3%; RR, 0.33; 95% CI, 0.19-0.56; p <.001; I2 = 0%). Overall, persistent VD (>1 month) was evaluable in 458 patients and occurred in 7.6%. Persistent VD was reduced after RALS (5.2% vs 10.2%; RR, 0.50; 95% CI, 0.26-0.99; p = .041; I2 = 60.1%).
Conclusion:
This meta-analysis demonstrates that RALS surgery for colorectal endometriosis was associated with a lower risk of both immediate and persistent VD compared with CL. These findings support the preferential consideration of RALS in patients requiring deep infiltrating endometriosis surgery with a high VD risk.
