Voiding Dysfunction After Robotic-Assisted Laparoscopic Surgery for Colorectal Endometriosis: A Systemactic Review and Meta-Analysis

Madar A, Alexandra Madar, Clément Ferrier, Ferrier C, Dabi Y, Yohan Dabi, Yohann Dabi, Meryl Dahan, Dahan M, Zerbib E, Elie Zerbib, Touboul C, Cyril Touboul, Émile Daraï, Emile Daraï, Daraï E
Journal of Minimally Invasive Gynecology · 2026 · doi:10.1016/j.jmig.2026.07.026 · PMID:42508684 · W7171389028
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Robotic-assisted laparoscopic surgery for colorectal endometriosis shows a lower incidence of immediate and persistent voiding dysfunction compared to conventional laparoscopy.

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Abstract

OBJECTIVE: To evaluate the incidence of voiding dysfunction (VD) after surgery for deep infiltrating endometriosis with colorectal involvement and 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 the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 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 a postoperative residual bladder volume of >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 the inclusion criteria for the qualitative synthesis and 10 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; p 1 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 = .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 deep infiltrating endometriosis surgery with a high VD risk.

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