GENERAL GYNECOLOGY Urinary dysfunction after colorectal resection for endometriosis: results of a prospective randomized trial comparing laparoscopy to open surgery Marcos Ballester, MD; Elisabeth Chereau, MD; Gil Dubernard, MD, PhD; Charles Coutant, MD, PhD; Marc Bazot, MD; Emile Daraï, MD, PhD OBJECTIVE: To evaluate urinary symptoms before and after colorectal resection for endometriosis using validated questionnaires. STUDY DESIGN: We randomly assigned 52 patients with colorectal en- dometriosis to undergo laparoscopically assisted or open colorectal re- section. The median follow-up was 19 months. Urinary symptoms were evaluated using the International Prostate Score Symptom and the Bris- tol Female Low Urinary Tract Symptoms questionnaires. RESULTS: Dysuria was observed in 29% of cases postoperatively. Us- ing Bristol Female Low Urinary Tract Symptoms and International Pros- tate Score Symptom scores, an alteration was observed for voiding symptoms (P = .01 and P = .006, respectively). No difference was ob- served between the laparoscopy and the open surgery group. An alter- ation of the International Prostate Score Symptom voiding symptoms was observed in the group that did not undergo nerve sparing surgery (P = .048). An alteration of the International Prostate Score Symptom voiding symptoms was observed for patients who underwent vaginal re- section (P = .01) and parametrial resection (P = .02). CONCLUSION: Our findings confirm that colorectal resection for endo- metriosis is a source of urinary dysfunction whatever the surgical route. Key words: BFLUTS (Bristol Female Low Urinary Tract Symptoms) questionnaire, colorectal endometriosis, IPSS (International Prostate Score Symptom) questionnaire, nerve sparing surgery, quality of life, urinary dysfunction Cite this article as: Ballester M, Chereau E, Dubernard G, et al. Urinary dysfunction after colorectal resection for endometriosis: results of a prospective randomized trial comparing laparoscopy to open surgery. Am J Obstet Gynecol 2011;204:303.e1-6. U rinary dysfunction is of major con- cern after surgery for deep infil- trating endometriosis (DIE), especially when the colorectum is involved. Al- though previous studies have demon- strated that colorectal resection for endometriosis was associated with a sig- nificant improvement in gynecologic and digestive symptoms and quality of life, 1-6 a high incidence of urinary side effects affecting quality of life has been reported to reach up to 17%. 7-9 Urinary dysfunction is linked to injury of the hypogastric plexus that contains the pelvic parasympathetic fibers re- sponsible for the voiding function of the bladder detrusor. 10,11 Previous retro- spective studies have underlined that the risk of urinary dysfunction depends on extension of surgery. Dubernard et al 7 reported incidences of urinary dysfunc- tion after resection of the uterosacral lig- aments, rectovaginal septum, and colo- rectum in 19.1%, 28.6% and 38.5% of cases, respectively. Nerve sparing sur- gery has been advocated to decrease the incidence of urinary side effects. Previ- ous studies have confirmed that the use of this technique decreases bladder dysfunction after uterosacral ligament resection. 8,10 Few data from validated question- naires are available about urinary dys- function after colorectal resection for endometriosis. In 2005, Daraï et al 1 re- ported a high incidence of urinary dys- function after colorectal resection by laparoscopy. More recently, Dousset et al, 12 by means of a qualitative question- naire, have shown that 16% of patients had a transient peripheral neurogenic bladder in a series of patients undergoing open surgery for rectal endometriosis. However, there is a lack of prospective data to assess the exact incidence of uri- nary dysfunction after colorectal resec- tion, especially taking into account the route and the use of nerve sparing surgery. In this study, we report the results on the secondary endpoint of the first prospective randomized trial comparing laparoscopy with open surgery for colorectal resection for endometriosis, focusing on pre- and postoperative urinary symptoms evalu- ated by validated questionnaires. MATERIALS AND METHODS Patients This prospective randomized study was conducted between January 2006 and December 2008. Inclusion criteria were as follows: patients more than 18 years of age with suspected colorectal endome- triosis based on symptoms, clinical ex- amination and imaging techniques in- From the Departments of Gynecology and Obstetrics (Drs Ballester, Chereau, Dubernard, Coutant, and Daraï) and Radiology (Dr Bazot), Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris, France. Received July 7, 2010; revised Sept. 3, 2010; accepted Nov. 2, 2010. Reprints not available from the authors. 0002-9378/$36.00 © 2011 Mosby, Inc. All rights reserved. doi: 10.1016/j.ajog.2010.11.011 Research www. AJOG.org APRIL 2011 American Journal of Obstetrics & Gynecology 303.e1