{"paper_id":"c406d5a1-f2dc-4f2f-b6bf-cfb968791221","body_text":"Vol.:(0123456789)\nInternational Urogynecology Journal (2025) 36:731–732 \nhttps://doi.org/10.1007/s00192-025-06143-9\nEDITORIAL\nKeep Your Bladder Small: Micturition Dysfunction in Deep Pelvic \nEndometriosis\nRok Šumak 1 · Tamara Serdinšek1\nPublished online: 16 April 2025 \n© The International Urogynecological Association 2025\nEndometriosis is a chronic disease that affects almost one \nin ten reproductive age women and extends beyond pelvic \npain and infertility, often affecting urinary function. It not \nonly involves pelvic organs, but also pelvic nerves. The pres-\nence of deep infiltrating endometriosis (DIE) can lead to a \nrange of micturition disorders, either through direct urinary \ntract involvement, indirect effects of chronic inflammation, \nnerve involvement, or postsurgical de novo voiding dysfunc-\ntion. As March marks endometriosis awareness month, it is \nessential to acknowledge these often-overlooked micturition \nproblems.\nLower urinary tract symptoms (LUTS) are present in 44% \nof patients with endometriosis [1 ]. DIE that infiltrates the \nbladder wall leads to fibrosis, reduced bladder compliance, \nand bothersome symptoms such as dysuria, urgency, fre-\nquency, suprapubic pain, and even hematuria in cases of \nfull-thickness bladder wall invasion. Some women experi-\nence cyclical worsening of symptoms during menstruation, \nmaking bladder involvement a crucial consideration in the \ndifferential diagnosis of chronic pelvic pain and urinary \ndysfunction. LUTS are also present in patients in which \nendometriotic nodules do not directly affect the bladder. \nThis could be due to involvement of nerves responsible for \nbladder innervation or due to chronic inflammation caused \nby endometriosis.\nSurgical excision of endometriotic nodules, often nec-\nessary for symptom relief and disease control, can cause \nadditional micturition problems. The extent of surgery, par-\nticularly when excision involves the bladder or pelvic nerves, \ndetermines postoperative bladder function. Most common \nsites of endometriosis nodule involvement include uterosa-\ncral ligaments, rectovaginal septum, and rectosigmoid colon. \nNerve damage during extensive excision of endometriotic \nnodules can impair bladder sensation and contractility. De \nnovo micturition dysfunction can occur in up to 30% of \npatients after DIE surgery [2 ]. In cases requiring surgery, \ncareful preoperative planning and postoperative monitoring \nare essential to recognize potential urinary complications \non time. According to Possover, neural damage during DIE \nsurgery leads to loss of sensation for bladder fullness and \nresults in reduced urinary frequency over time. This gradu-\nally increases bladder capacity, with secondary impairment \nof bladder elasticity and contractility (myogenic damage). \nResulting postvoid residual volumes increase over time and \nsubsequently deteriorate bladder contractility even more. \nThese symptoms can appear up to 7 years after DIE surgery \n[3].\nFollow up of patients after DIE surgery should not focus \nonly on disease recurrence but also on voiding function. \nPhysicians should pay attention to reduced urinary fre -\nquency and weak urinary stream. Post-void residual urine \nshould be controlled regularly. In case of higher post-void \nvalues, intermittent self-catheterization must be started \nearly enough, before bladder myogenic damage becomes \nirreversible.\nAs awareness of endometriosis grows, so must recogni-\ntion of its impact on urinary tract (dys)function. Recognizing \nmicturition problems as part of a comprehensive endometri-\nosis care strategy is vital for improving patient outcomes. By \nemphasizing early diagnosis, recognizing de novo postopera-\ntive micturition dysfunction, multidisciplinary approach, and \ntargeted therapies, we can ensure the improvement of quality \nof life in women with DIE.\n * Rok Šumak \n roksumak@gmail.com\n1 Department of General Gynecology and Gynecological \nUrology, Clinic for Gynecology and Perinatology, University \nMedical Centre Maribor, Maribor, Slovenia\n\n732 International Urogynecology Journal (2025) 36:731–732\nReferences\n 1. Gabriel I, Vitonis AF, Missmer SA, Fadayomi A, DiVasta AD, \nTerry KL, et al. Association between endometriosis and lower \nurinary tract symptoms. Fertil Steril. 2022;117(4):822–30.\n 2. Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Daraï \nE. Urinary complications after surgery for posterior deep infil-\ntrating endometriosis are related to the extent of dissection and \nto uterosacral ligaments resection. J Minim Invasive Gynecol. \n2008;15(2):235–40.\n 3. Possover M. Pathophysiologic explanation for bladder reten-\ntion in patients after laparoscopic surgery for deeply infiltrat-\ning rectovaginal and/or parametric endometriosis. Fertil Steril. \n2014;101(3):754–8.\nPublisher’s Note Springer Nature remains neutral with regard to \njurisdictional claims in published maps and institutional affiliations.","source_license":"public-domain-us","license_restricted":false}