{"paper_id":"a578793c-fe2c-4956-9929-650b682ed39a","body_text":"Abstract\nPurpose\nRadical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires.\nMethods\nAll women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12 months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6 months after surgery.\nMain results\nA total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0–7 and 2, 0–7, respectively) and at 12 months (3, 0–8 and 2, 0–7), compared to pre-operative levels (9, 1–10 and 3, 0–7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0–21) pre-operatively and 2 (0–18) after 6 months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2–28.9) vs. 22.7 (12.2–31) post-operatively (p = 0.004).\nConclusions\nThe nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.\nSimilar content being viewed by others\nReferences\nBuck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J et al (2011) Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil Steril 96:360–365\nGiudice LC (2010) Clinical practice. Endometriosis. N Engl J Med 362(25):2389–2398\nUccella S, Cromi A, Casarin J, Bogani G, Pinelli C, Serati M et al (2014) Laparoscopy for ureteral endometriosis: surgical details, long-term follow-up, and fertility outcomes. 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FG: project developmentand manuscript editing.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors have no conflict of interests to disclose.\nEthical approval\nAll procedures performed were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\nInformed consent\nInformed consent was obtained from all individual participants included in the study.\nRights and permissions\nAbout this article\nCite this article\nUccella, S., Gisone, B., Serati, M. et al. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet 298, 639–647 (2018). https://doi.org/10.1007/s00404-018-4852-z\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-018-4852-z","source_license":"CC0","license_restricted":false}