VOIDING DYSFUNCTION AFTER ROBOTIC-ASSISTED LAPAROSCOPIC SURGERY FOR COLORECTAL ENDOMETRIOSIS: A SYSTEMACTIC REVIEW AND META-ANALYSIS

OBJECTIVE: To evaluate the incidence of voiding dysfunction (VD) after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement and to compare outcomes between conventional laparoscopy (CL) and robotic-assisted laparoscopic surgery (RALS). DATA SOURCES: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines using PubMed, Embase, the Cochrane Library, and Web of Science. METHODS OF STUDY SELECTION: Eligible studies included prospective, retrospective, or randomized trials reporting VD after RALS for colorectal endometriosis. VD was defined according to reported criteria, including need for intermittent self-catheterization, subjective dysuria, or postoperative residual bladder volume >100 mL. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I² statistic. TABULATION, INTEGRATION AND RESULTS: Eleven studies met inclusion criteria for the qualitative synthesis and ten for the meta-analysis, comprising 728 patients (225 CL; 503 RALS). Overall VD was observed in 52 patients (7.1%). VD was less frequent after RALS than CL (4.4% vs 13.3%; RR = 0.33; 95% CI: 0.19-0.56; p1 month) was evaluable in 458 patients and occurred in 7.6%. Persistent VD was reduced after RALS (5.2% vs 10.2%; RR = 0.50; 95% CI: 0.26-0.99; p=0.041; I²=60.1%). CONCLUSION: This meta-analysis demonstrates that RALS surgery for colorectal endometriosis was associated with a lower risk of both immediate and persistent VD compared with CL. These findings support the preferential consideration of RALS in patients requiring DIE surgery with a high VD risk.