Urinary function worsens over time after laparoscopic surgery for endometriosis

Key takeaways:

• After surgery, 12.1% of women sought treatment for bladder symptoms and 28% reported at least one urinary tract infection.
• Women reported worsening in filling, voiding, incontinence and quality of life after surgery.

Women who underwent laparoscopic surgery for endometriosis treatment reported progressive, but mild, urinary function deterioration over time, according to study results published in the Journal of Minimally Invasive Gynecology.

“Urinary dysfunction is common in women with endometriosis both pre- and postoperatively,” Kimberly Nguyen, MD, from the School of Clinical Medicine at the University of New South Wales Sydney and the Gynecology Research and Clinical Evaluation Group, Sydney, Australia, and colleagues wrote. “While not life-threatening, urinary symptoms may cause significant distress and impair a woman’s quality of life, with a paucity of data examining long-term urinary function following surgical management of endometriosis.”

Nguyen and colleagues conducted a nested cohort study within a larger randomized controlled trial with 289 women with histologically confirmed endometriosis who consented to participating in the cohort study. All participants were recruited from two University-affiliated hospitals in Sydney from April 2012 to November 2019 and underwent laparoscopy for benign gynecological conditions. Urinary function was assessed at baseline and from February to October 2020 via validated questionnaires across domains of filling, voiding, incontinence and quality of life, with higher scores indicating greater severity in symptoms.

During a mean follow-up period of 50 months, 12.1% of women had sought treatment for bladder symptoms and 28% reported at least one urinary tract infection since endometriosis surgery. Researchers observed worsening of symptoms, indicated by higher questionnaire scores, from before to after endometriosis surgery in filling (2.27 vs. 3.32), voiding (0.93 vs. 2.02), incontinence (1.06 vs. 2.32) and quality of life (0.83 vs. 2.13; P < .001 for all).

Researchers noted no statistically significant difference in urinary questionnaire scores among women with and without uterovesical endometriosis and in any parameter when comparing endometriosis stages.

Women with postoperative urinary retention had a worse mean voiding score compared with women without (3.24 vs. 1.94; P = .017), and women with postoperative urinary tract infection had a higher mean frequency score compared with women without (5.17 vs. 3.24; P = .016).

“The strengths of this prospective study include its large sample size and long-term follow-up, representing women with a wide variation in age, parity, menopausal status and BMI, that strengthens its external validity,” the researchers wrote. “Findings from this study will enable clinicians to appropriately counsel and reassure patients on the long-term urinary effects following the surgical removal of endometriosis.”