Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study

Objective: To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis.

Design: Prospectively collected data regarding the function of the pelvic organs.

Setting: Tertiary endometriosis referral unit, Aarhus University Hospital.

Sample: A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis.

Methods: The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed.

Main outcome measures: Pre- and postoperative function of the pelvic organs was compared, and risk factors for improved/impaired function were identified.

Results: A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P = 0.002) in bladder filling problems (F-score) was observed 1 year after surgery, primarily caused by a significant decrease in bladder pain (P = 0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P = 0.0001) and decrease in worries about sexual life (P = 0.001) was seen 1 year after surgery. Frequency of defecation was significantly increased 1 year after surgery (P = 0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR 5.40; P = 0.002) of increased incontinence problems (I-score) 1 year after surgery.

Conclusion: A significant and clinically relevant improvement in urinary and sexual function 1 year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient- or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients.

Tweetable abstract: Rectal resection for endometriosis does not impair urinary and sexual function 1 year after surgery.