Minimally Invasive Surgery for Excision of Clinically Suspected Endometriosis Improves Perception of Lower Urinary Symptoms

OBJECTIVE: To determine if surgical excision of suspected pelvic endometriosis patient's complaints of voiding dysfunction. DESIGN: This is a retrospective cohort study. SETTING: A large academic institution with a single urogynecologist provider between 2020 and 2021. PARTICIPANTS: Patients with clinically-suspected endometriosis who also underwent minimally invasive surgical excision of endometriotic lesions were included. Clinical suspicion was based on symptoms including dysmenorrhea, pelvic pain, dyspareunia, urinary dysfunction, and dyschezia. INTERVENTIONS: A questionnaire was administered postoperatively to assess the perceived change in the severity of lower urinary tract symptoms (LUTS), specifically urinary urgency, frequency, and nocturia. The questionnaire was administered between 1 and 25 months after surgery. Documented pre-operative LUTS assessment was compared to postoperative symptoms. RESULTS: Of 71 patients (76.3% response rate), 90.1% (n=64) of patients with suspected endometriosis had preoperative LUTS. Of those with LUTS, symptoms were significantly decreased after surgical excision, a mean of 9.4±6.9 months after surgery. Endometriosis or adenomyosis was histologically confirmed in 81.7% (n=58) of participants: endometriosis, 69.0% (n=49); adenomyosis, 51.9% (n=14) of those who underwent hysterectomy. 87.7% (n=43) of patients with confirmed endometriosis had preoperative LUTS. Pathology-positive patients with preoperative LUTS experienced a significant reduction in symptoms: urinary urgency (p <.0001), frequency (p <.0001), and nocturia (p <.0001) postoperative. Most endometriotic lesions were in the peritoneum (77.6%, n=38) and only 2.1% (n=1) were located on the bladder. CONCLUSION: LUTS are often overlooked or not discussed enough by healthcare providers in connection with endometriosis. Excision of suspected endometriosis by minimally invasive surgical intervention provided significant relief of LUTS, even in the absence of visible bladder lesions. Surgical management has an increasing clinical role in the improvement of LUTS.