{"paper_id":"ae541ac4-557a-4214-97c6-7489d9ce7d4f","body_text":"Abstract\nIntroduction and Hypothesis\nUrinary tract endometriosis (UTE) commonly presents with urinary urgency, frequency, retention, and hesitancy. Although surgical excision consistently improves storage symptoms postoperatively, voiding dysfunction often persists due to interactions between clearing lesions, potential neural injury, and pelvic floor dysfunction. Understanding these mechanisms is vital for optimizing outcomes and minimizing long-term morbidity.\nMethods\nWe conducted a structured narrative review on surgical management of endometriosis with urinary symptom predominance in PubMed, Scopus, and Cochrane. We thematically synthesized studies on surgical techniques, urinary outcomes, pelvic floor dysfunction, and adjunct neuromodulation to provide insight into current practices, mechanistic understanding, and new approaches.\nResults\nInitially, 928 studies were identified, 798 titles and abstracts were screened after elimination of duplicates, and 63 studies were included after full text screening. Continued improvements in storage symptoms were seen regardless of surgical approach (partial cystectomy, bladder shaving, ureteral procedures) but up to 50% of patients experienced persistent voiding dysfunction. This was due to potential neural injury, fibrosis, and hypertonicity of the pelvic floor. Although nerve-sparing techniques had less dysfunction, they did not eliminate it. Adjuncts, including pelvic floor physiotherapy and neuromodulation, were supported as novel therapies. Advanced imaging techniques might improve risk stratification prior to surgery but prospective level evidence is lacking.\nConclusions\nThe significant proportion of patients with voiding dysfunction after UTE surgery indicates a need for multi-disciplinary pathways. In addition to lesion excision, co-management with pelvic floor rehabilitation, advanced imaging, and neuromodulation may optimize recovery. There are important priorities for the future, including standardized urodynamic outcomes and prospective study designs.\nSimilar content being viewed by others\nData Availability\nThis article is a narrative review. All data used in this manuscript were obtained from previously published studies and are available in the cited sources. No new datasets were generated or analyzed for this work.\nReferences\nPanel P, Huchon C, Estrade-Huchon S, Le Tohic A, Fritel X, Fauconnier A. Bladder symptoms and urodynamic observations of patients with endometriosis confirmed by laparoscopy. 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The research was conducted as part of the authors’ academic and professional interests without any external financial support.\nAuthor information\nAuthors and Affiliations\nContributions\nConceptualization: ZYM, SM, IS; Methodology: ZYM, SM, IS; Validation: ZYM, SM; Formal analysis: ZYM, SM, IS, SC, HMY, PB; Investigation: SC, HMY, PB; Resources: ZYM, SM, IS; Data curation: ZYM, SM, IS, SC, HMY, PB; Writing—original draft preparation: ZYM, IS, SC, HMY, PB; Writing—review and editing: ZYM, SM, IS; Visualization: ZYM, SM, IS; Supervision: ZYM, SM.\nCorresponding author\nEthics declarations\nConflicts of Interest\nThe authors declare that they have no conflicts of interest relevant to this study.\nAdditional information\nHandling Editor: Rok Šumak\nEditor in Chief: Kaven Baessler\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nAppendix\nAppendix\n-\n1.1.\nSearch String PubMed:\n(\"Endometriosis\"[Mesh] OR endometriosis OR \"deep infiltrating endometriosis\" OR DIE) AND (\"Urinary Tract\"[Mesh] OR \"Urinary Bladder\"[Mesh] OR \"Ureter\"[Mesh] OR urinary OR bladder OR ureter OR urethra OR \"urinary tract endometriosis\") AND (\"Surgical Procedures, Operative\"[Mesh] OR surgery OR excision OR resection OR laparoscopy OR laparoscopic OR robotic OR cystectomy OR shaving OR ureterolysis OR \"ureteral resection\") AND (\"Urination Disorders\"[Mesh] OR LUTS OR \"voiding dysfunction\" OR retention OR incontinence OR urgency OR frequency OR dysuria).\n-\n2. Search String Scopus:\nEndometriosis AND (urinary OR bladder OR ureter* OR urethra*) AND (surg* OR excis* OR resect* OR laparoscop* OR robotic OR cystectom* OR ureterolysis) AND (LUTS OR \"urination disorder*\" OR \"voiding dysfunction\" OR incontinence OR urgency OR frequency OR dysuria*).\n-\n3. Search String Cochrane:\nEndometriosis AND (urinary OR bladder OR ureter* OR urethra*) AND (surg* OR excis* OR resect* OR laparoscop* OR robotic OR cystectom* OR ureterolysis) AND (LUTS OR \"urination disorder*\" OR \"voiding dysfunction\" OR incontinence OR urgency OR frequency OR dysuria*).\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nMotiwala, Z.Y., Misra, S., Sharma, I. et al. Surgical Management of Urinary-Symptom-Dominant Endometriosis: Addressing Persistent Voiding Dysfunction and Pelvic Floor Factors. Int Urogynecol J (2025). https://doi.org/10.1007/s00192-025-06488-1\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s00192-025-06488-1","source_license":"CC0","license_restricted":false}