Introduction and hypothesis
The objective was to assess the association between lower urinary tract disease (LUTD) and the presence of endometriosis at different anatomical sites.
Our prospective cross-sectional observational study evaluated 138 women with deep infiltrating endometriosis who had undergone preoperative evaluation of urodynamics and detailed assessment of lower urinary tract symptoms between August 2013 and May 2016. After laparoscopy, the anatomical sites of histologically confirmed endometriosis lesions were mapped.
The presence of endometriosis in the bladder demonstrated significant negative angular coefficients for bladder compliance (mL/cmH2O) (P = 0.007; B = −54.65; 95%CI: −93.76 to −15.51) and for maximum cystometric capacity (mL; P = 0.001; B = −39.79; 95%CI: −62.51 to −17.06), whereas endometriosis in the parametrium showed significant positive coefficients for opening pressure (cmH2O) (P = 0.016; B = 5.89; 95%CI: 1.10–10.69) and post-void residual (mL) (P = 0.015; B = 31.34; 95%CI: 6.14–56.55). The presence of endometriosis in the bladder was a statistically significant independent predictor of low bladder compliance (P < 0.001; OR = 30.10; 95%CI: 9.48–95.55), whereas endometriosis in the parametrium was a statistically significant independent predictor of both abnormal residual urine (P = 0.019; OR = 5.21; 95%CI: 1.32–20.64) and bladder outlet obstruction (P = 0.011; OR = 7.91; 95%CI: 1.61–38.86). Correspondence analysis suggested two possible independent ways through which endometriosis acts on the genesis of urinary dysfunctions.
Our findings strongly suggest that endometriosis involving the bladder might disturb storage function, whereas endometriosis in the parametrium disturbs the voiding phase.
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Our special thanks to Dr Alice Cristina Coelho Brandão for interpreting the MRI findings, Dr Leigh J Passman for a review of the English manuscript, and Dr Felipe Ventura Sessa and Camilla Gabriely Souza Guerra for technical help with the database and writing assistance.
Conflicts of interest
Source of financial funding
Brazilian Federal Government: PIBIC/PIBITI/PIP Programs of the Fundação Instituto Oswaldo Cruz (Fiocruz) of the Ministry of Health and the National Council for Scientific and Technological Development (CNPq) of the Ministry of Science and Technology.
Institutional review board approval
CAAE 15381613.0.0000.5269. Research Ethics Committee of the National Fernandes Figueira Institute for Women, Children, and Adolescent Health (IFF), Ministry of Health.
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de Resende Júnior, J.A.D., Crispi, C.P., Cardeman, L. et al. Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease. Int Urogynecol J 29, 1349–1358 (2018). https://doi.org/10.1007/s00192-017-3531-0
- Lower urinary tract symptoms
- Bladder voiding function