Preoperative evaluation of posterior deep-infiltrating endometriosis demonstrates a relationship with urinary dysfunction and parametrial involvement

Study objective: To estimate the association between urinary symptoms and quality of life in patients with posterior deep-infiltrating endometriosis (DIE) with anatomical locations of endometriosis.

Design: Prospective nonrandomized study (Canadian Task Force classification II-2).

Setting: Tertiary care hospital.

Patients: One hundred fifty-three patients with DIE and 28 control subjects.

Interventions: Clinical examination completed using transvaginal ultrasonography and magnetic resonance imaging.

Measurements and main results: Urinary symptoms and quality of life were evaluated using the International Prostate Symptom Score (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaires. There was a higher incidence of urinary symptoms and a high IPSS in patients with posterior DIE compared with the control group. The IPSS questionnaire detected a relation between parametrial endometriosis and voiding symptoms (p = .03), altered quality of life (p = .02), and a high total score (p = 0.04) in patients with posterior DIE. No difference in urinary symptoms and total BFLUTS score was observed between the groups. A relation was found between parametrial endometriosis and urinary symptoms (p = .02), altered quality of life (p = .04), and high total score (p = .03) in patients with posterior DIE. At multivariable analysis, a correlation was found between parametrial endometriosis and IPSS total score (p = .03), IPSS voiding symptoms (p = .04), and IPSS quality of life (p = .009). Similarly, a correlation was found between parametrial endometriosis and BFLUTS symptoms (p = .003), BFLUTS quality of life (p = .003), and BFLUTS total score (p = .007).

Conclusion: Patients with posterior DIE have a high incidence of urinary symptoms. Moreover, parametrial endometriosis is associated with altered urinary function and should be systematically evaluated in these patients.