Incidence of pre- and postoperative urinary dysfunction associated with deep infiltrating endometriosis: relevance of urodynamic tests and therapeutic implications.

Although many series have been published on the management of digestive or urinary deep infiltrating endometriosis (DIE), few data exist on pre- and postoperative urinary dysfunction (UD) and urodynamic tests. Hence, the objective of this review was to evaluate the pre- and postoperative incidence of UD and the contribution of urodynamic tests as well as their therapeutic implications. Studies published between January 1995 and April 2012, available in the databases Medline, Embase or the Cochrane Library and responding to a key word algorithm were selected. Studies were classified according to their level of evidence in the Canadian Task Force classification. Sixty-three studies were included in this review. The incidence of preoperative UD is unknown in patients with DIE without colorectal involvement but ranges from 2% to 48% in patients with colorectal endometriosis. About half of all the patients had abnormal urodynamic test results. DIE surgery is associated with a risk of urinary dysfunction mainly corresponding to de novo voiding dysfunction in 1.4% to 29.2% of cases with a mean value of 4.8%. The rate of persistent voiding dysfunction ranges from 0 to 14.7% with a mean value of 4.6%. Risk factors of postoperative UD are the need for partial colpectomy, parametrectomy and patients requiring colo-anal anastomosis. For patients with urinary tract endometriosis, the incidence of preoperative UD is comprised between 24.4% and 79.2% with a rate of postoperative voiding dysfunction ranging from 0% to 16.9% with a mean value of 11.1%. Prevention of postoperative UD is based on nerve-sparing surgery. Treatment of voiding dysfunction requires self-catheterization. There is a lack of data on medical treatment and surgical techniques to manage postoperative UD. More effort needs to be made to detect preoperative UD associated with DIE. Preoperative evaluation by urodynamic tests and possibly electrophysiology could be of interest especially in patients with risk factors. The current review underlines the difficulties of establishing clear recommendations due to heterogeneity of the studies and the absence of a consensual definition of UD.