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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, 4, rue de la Chine, 75020 Paris, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France.
Objective:
To evaluate the incidence of voiding dysfunction (VD) after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement and to 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 PRISMA 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 postoperative residual bladder volume >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 inclusion criteria for the qualitative synthesis and ten 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<0.001; 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=0.041; 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 DIE surgery with a high VD risk.
