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Robotic Excision of Endometriosis Improves Perception of Lower Urinary Tract Symptoms

Robotic Excision of Endometriosis Improves Perception of Lower Urinary Tract Symptoms

Presenting Author(s)

Tamar Yacoel, MD

Resident
Hackensack University Medical Center
Sherman Oaks, California, United States

Co-Author(s)

KB

Kelly Budge, BA, MRes

Medical Student
Hackensack Meridian School of Medicine
Park Ridge, New Jersey, United States
KS

Khashayar Shakiba, MD, FPMRS

Division Director of Female pelvic Medicine and Reconstructive Surgery, Department of OBGYN
Hackensack University Medical Center
Hackensack, New Jersey, United States

Objectives: Lower urinary tract symptoms (LUTS) including urinary urgency, frequency, and nocturia are highly prevalent.  Although not historically associated with endometriosis, recent studies have shown an increased prevalence of LUTS in patients with endometriosis. Surgical excision is the gold standard for the diagnosis of endometriosis but it remains unclear if surgical intervention would provide LUTS relief. Our aim was to determine if surgical excision of suspected endometriosis, especially on the pelvic side wall, is correlated with perceived improvement of voiding dysfunction.

Methods: This retrospective cohort study evaluated 71 women aged 18-59 years with pelvic pain and pelvic floor dysfunction (PFD) who underwent a robotic-assisted excision of suspected pelvic sidewall endometriosis and hypogastric plexus neurolysis with a single provider at an academic institution between 2020-2021. A post-operative survey assessed perceived changes in the severity of voiding dysfunction, including urinary urgency, frequency, and nocturia, at a mean of 9.42±6.99 months after surgery. Institutional review board was obtained and all patients provided informed consent. 

Results: Of the 71 women assessed, 49 (69.01%) had endometriosis and 13 out of 26 women who underwent hysterectomies had adenomyosis (total n=58 for endometriosis and/or adenomyosis positive). Additionally, 73.6% (n=53) of all patients had gross peritoneal inflammation. Post-operatively, all patients experienced significant improvement in LUTS regardless of pathology, with reductions observed in urinary urgency (52.9% vs 26.1%, p< 0.0001), urinary frequency (60.0% vs 31.9%, p< 0.0001), nocturia (mean voids per night 1.83 to 0.87, p< 0.0001), difficulty emptying bladder (37.1% vs 14.5%, p=0.0001), and frequent UTIs (22.9% vs 5.8%, p=0.009). When stratified by pathology positive or negative for endometriosis and/or adenomyosis, both groups showed significant improvement in LUTS. Similarly, there was no significant difference in the rate of LUTS improvement between patients who did (n=26) versus did not (n=45) have a hysterectomy at time of surgery. The duration of follow-up (less than or greater than 6 months) did not impact the percent changes in LUTS before and after surgery (range=7-22 months).

Conclusions: Minimally invasive surgical excision of suspected endometriosis or inflamed peritoneum overlying the pelvic sidewall appears to relieve LUTS significantly. Regardless of pathology findings, symptom improvement rates remained consistent, even with increased time intervals following surgery. We suggest that inflammation along the pelvic sidewall may irritate the inferior hypogastric nerve plexus, contributing to LUTS in endometriosis, although the etiology is not yet fully understood. These findings underscore the potential clinical importance of inferior hypogastric plexus inflammation in PFD, and the growing significance of surgical management in alleviating LUTS in women with endometriosis.