Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience

Andrea Rosati, A Rosati, M Pavone, Matteo Pavone, F Campolo, Federica Campolo, A De Cicco Nardone, Alessandra Nardone, D Raimondo, Diego Raimondo, R Serracchioli, Giovanni Scambia, G Scambia, Manuel Maria Ianieri, M M Ianieri
Facts, views & vision in ObGyn · 2022 · vol. 14(2) , pp. 121–127 · doi:10.52054/fvvo.14.2.016 · PMID:35781108 · PMC10191710 · W4283776475
article OA: gold CC0 ⤵ 10 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study evaluated functional outcomes and complications in 23 patients undergoing radical hysterectomy for deep endometriosis, finding significant pain reduction but no change in sexual or urinary function, with a risk of post-operative bladder deficit.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This single-center study evaluated post-operative function and complications after nerve-sparing radical hysterectomy with posterolateral parametrial resection in 23 patients with parametrial deep endometriosis. Using validated questionnaires, including VAS for pain and tools assessing gastrointestinal (KESS, GQLI), urinary (BFLUTS), and sexual function (FSFI), the authors found significant reductions in dyschezia, dyspareunia, and chronic pelvic pain, along with improvement in gastrointestinal function. In contrast, sexual function and urinary symptoms were not significantly improved. The paper reports a not-negligible risk of postoperative bladder voiding deficit despite the nerve-sparing approach, and this is centrally about endometriosis—specifically parametrial deep endometriosis treated with nerve-sparing radical hysterectomy.

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Abstract

BACKGROUND: Deep endometriosis (DE) usually creates a distortion of the retroperitoneal anatomy and may infiltrate the parametria with an oncomimetic pathway similar to cervical cancer. The condition represents a severe manifestation of endometriosis that may result in a functional impairment of the inferior hypogastric plexus. An extensive surgical resection may be required with an associated risk of increased neurogenic postoperative pelvic organ dysfunction. OBJECTIVES: To evaluate the post-operative function and complications following hysterectomy with posterolateral parametrial resection for DE. MATERIALS AND METHODS: In total, 23 patients underwent radical hysterectomy for DE with the parametria involved. The severity of pain was assessed by the Visual Analogue Scale (VAS) score. The KESS, GQLI, BFLUTS and FSFI were used to examine the gastrointestinal, urinary and sexual functions respectively. Intra and post-operative complications were recorded. MAIN OUTCOME MEASURES: The main outcomes were gastrointestinal, urinary and sexual function and intra and post-operative complications. RESULTS: Dyschezia, dyspareunia and chronic pelvic pain were significantly reduced following hysterectomy. Furthermore, an improvement of gastrointestinal function was observed, while sexual functions, examined by FSFI and urinary symptoms, examined by BFLUTS, was not shown to be significant. CONCLUSION: The modified nerve-sparing radical hysterectomy for DE results in an improvement of symptoms. Nevertheless, despite the nerve-sparing approach, this procedure may be associated with a not-negligible risk of post-operative bladder voiding deficit. WHAT IS NEW?: This is the first study that focuses on parametrial endometriosis using validated questionnaires to assess functional outcomes following radical hysterectomy for DE.

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Outcome instruments

VAS-pain

Condition tags

endometriosischronic_pelvic_paindyspareunia

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