Diagnostic Accuracy and Surgical Outcomes of Deep Infiltrating Endometriosis Involving the Urinary Tract: A Systematic Review

Diagnostic Accuracy and Surgical Outcomes of Deep Infiltrating Endometriosis Involving the Urinary Tract: A Systematic Review Surgical Outcomes of Deep Infiltrating Endometriosis Involving the Urinary Tract DOI: https://doi.org/10.54393/pjhs.v7i5.3841Keywords: Deep Infiltrating Endometriosis, Urinary Tract, Bladder, Ureter, MRI, Transvaginal Ultrasonography, SurgeryAbstract Deep infiltrating endometriosis (DIE) involving the urinary tract represents a severe phenotype of endometriosis that poses major diagnostic and surgical challenges. Accurate preoperative imaging and optimal surgical management are essential to prevent silent obstruction and long-term renal damage. Objectives: To evaluate the diagnostic accuracy of imaging modalities and to summarize surgical outcomes in patients with urinary tract deep infiltrating endometriosis. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and the Cochrane Library were searched for studies published between January 2018 and March 2025. Diagnostic-accuracy studies and outcome-only surgical cohorts were synthesized as distinct evidence streams. Methodological quality was assessed using QUADAS-2 for diagnostic studies and the Newcastle–Ottawa Scale for surgical cohorts. Results: Twelve studies were included, comprising two formal diagnostic-accuracy studies and ten surgical outcome cohorts. Transvaginal ultrasonography using the IDEA protocol demonstrated high diagnostic performance (sensitivity 93.9%, specificity 99.4%, accuracy 98.7%), while magnetic resonance imaging showed good sensitivity (83.3%) and excellent negative predictive value (93.5%). Most surgical cohorts reported favorable postoperative outcomes with low urinary tract–specific recurrence when managed in specialized centers. However, none of the studies reported confidence intervals or complete diagnostic contingency matrices. 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