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Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013

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Gynecological Surgery

Abstract

Urinary tract endometriosis (UTE) is a rare form of deep infiltrating endometriosis. We studied the operative treatment of UTE and evaluated postoperative recurrences and fertility outcomes. This is a retrospective cohort study of 53 women who underwent operative treatment for UTE in 2004–2013 at Helsinki University Hospital, and were followed-up until the end of 2014. The data were gathered from the hospital’s electronic database. The main outcome measures were complications, reoperations, postoperative pregnancies, and deliveries. Preoperative diagnosis was accurate in 72 % with bladder endometriosis and in 93 % with ureteral disease. Thirty-one (58 %) of the 53 operations were performed via laparoscopy. Postoperative complications requiring re-intervention occurred in five cases (9 %). Five reoperations were performed in four cases due to endometriosis recurrence, only two due to recurrence of UTE (4 %). Twenty-eight women wished for pregnancy; 18 (64 %) of them conceived. Infertility treatment was needed in 20 (71 %) cases. Twelve (75 %) women delivered via cesarean section; intraoperative difficulties occurred in ten (83 %). The complication rate with UTE operations is acceptable and recurrences are rare. Infertility is common, but 57 % of those who wished for a child succeeded. A majority of the deliveries involved unplanned and complicated cesarean section.

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Acknowledgments

This study was supported by Helsinki University Central Hospital Research funds.

The authors would like to thank Arja-Riitta Pauna for radiological consultation and Maarit Mentula for her kind advice with the statistics.

Authors’ contribution

L Saavalainen performed data collection and managing, data analysis, and manuscript writing. O Heikinheimo was responsible for project development, data analysis, and manuscript editing. A Tiitinen was responsible for project development and manuscript editing. P Härkki was responsible for project development, data managing, data analysis, and manuscript editing.

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  1. Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Sofianlehdonkatu 5, PO Box 610, FI-00029 HUS, Helsinki, Finland

    Liisu Saavalainen, Oskari Heikinheimo, Aila Tiitinen & Päivi Härkki

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  1. Liisu Saavalainen
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Correspondence to Päivi Härkki.

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Saavalainen, L., Heikinheimo, O., Tiitinen, A. et al. Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013. Gynecol Surg 13, 435–444 (2016). https://doi.org/10.1007/s10397-016-0958-0

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