Stefano Uccella1,2, Baldo Gisone3, Maurizio Serati3, Sara Biasoli3, Nicola Marconi4, Gloria Angeretti5, Valerio Gallotta6, Silvia Cardinale3, Stefano Rausei7, Gianlorenzo Dionigi8, Giovanni Scambia6,9, Fabio Ghezzi3. 1. Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S., Largo Agostino Gemelli, 8, 00168, Roma, Italy. stefucc@libero.it. 2. Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy. stefucc@libero.it. 3. Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy. 4. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. 5. Radiology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy. 6. Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S., Largo Agostino Gemelli, 8, 00168, Roma, Italy. 7. Department of Surgery, Gallarate Hospital, Gallarate, Italy. 8. Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital "G. Martino", University of Messina, Messina, Italy. 9. Università Cattolica del Sacro Cuore, Roma, Italy.
Abstract
PURPOSE: Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires. METHODS: All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12 months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6 months after surgery. MAIN RESULTS: A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0-7 and 2, 0-7, respectively) and at 12 months (3, 0-8 and 2, 0-7), compared to pre-operative levels (9, 1-10 and 3, 0-7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0-21) pre-operatively and 2 (0-18) after 6 months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2-28.9) vs. 22.7 (12.2-31) post-operatively (p = 0.004). CONCLUSIONS: The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.
PURPOSE: Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires. METHODS: All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12 months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6 months after surgery. MAIN RESULTS: A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0-7 and 2, 0-7, respectively) and at 12 months (3, 0-8 and 2, 0-7), compared to pre-operative levels (9, 1-10 and 3, 0-7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0-21) pre-operatively and 2 (0-18) after 6 months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2-28.9) vs. 22.7 (12.2-31) post-operatively (p = 0.004). CONCLUSIONS: The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.
Entities:
Keywords:
Bladder function; Deep infiltrating endometriosis; Laparoscopy; Nerve sparing; Rectal function; Sexual function
Authors: Manuel Maria Ianieri; Diego Raimondo; Andrea Rosati; Laura Cocchi; Rita Trozzi; Manuela Maletta; Antonio Raffone; Federica Campolo; Giuliana Beneduce; Antonio Mollo; Paolo Casadio; Ivano Raimondo; Renato Seracchioli; Giovanni Scambia Journal: Int J Gynaecol Obstet Date: 2022-01-20 Impact factor: 4.447