title: Bladder symptoms and urodynamic observations of patients with endometriosis confirmed by laparoscopy.
abstract: OBJECTIVE
  Patients with deep infiltrating pelvic endometriosis (DIE) often describe having lower urinary tract symptoms (LUTS). Bladder pain syndrome in women is also often associated with endometriosis. In this study, we aimed to describe the characteristics of LUTS and urodynamic observations in patients with posterior endometriosis versus those with posterior and anterior endometriosis.
  
  
  METHODS
  This was a prospective observational study of 30 patients from two gynecologic surgical settings with experience in DIE surgery. All patients underwent preoperative standardized investigation including detailed evaluation of LUTS and urodynamic studies. During surgery, endometriosis locations were recorded and correlated to symptoms and urodynamic observations.
  
  
  RESULTS
  Twenty-three patients (76.7 %) had one or more LUTS symptoms and 29 (96.7 %) had one or more abnormalities at urodynamic examination. At surgery, all patients had posterior endometriosis and ten of them also had anterior endometriosis. Patients with anterior endometriosis had increased bladder sensation (90.0 % versus 45.0 %, p = 0.024) and painful bladder filling (70.0 % versus 30.0, p = 0.04) compared with patients with posterior endometriosis only. Voiding symptoms (60.0 %), impairment of flowmetry (30.0 %), and increased maximum urethral closure pressure (90.0 %) were frequent and not correlated with any specific location.
  
  
  CONCLUSIONS
  Endometriosis infiltrating the bladder wall is associated with painful bladder symptoms. Dysfunctional voiding suggests an impairment of the inferior hypogastric plexus by posterior DIE. Clinical preoperative evaluation of bladder function should be systematic; urodynamic tests could be of interest in selected patients with DIE. Endometriosis may be a major cause of bladder pain syndrome.
authors.affiliation: Department of Gynecology & Obstetrics, Centre Hospitalier André Mignot, Versailles, France. ppanel@ch-versailles.fr.
authors.forename: Pierre
authors.identifier: http://orcid.org/0000-0002-2163-3435
authors.initials: P
authors.lastname: Panel
authors.affiliation: Department of Gynecology & Obstetrics, Centre Hospitalier Intercommunal de Poissy - Saint-Germain, Poissy, France.|Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Department of Gynecology & Obstetrics, Centre Hospitalier Intercommunal de Poissy - Saint-Germain, Poissy, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Estrade-Huchon
authors.affiliation: Department of Gynecology & Obstetrics, Centre Hospitalier André Mignot, Versailles, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Le Tohic
authors.affiliation: Poitiers University, INSERM CIC802, University Hospital of Poitiers, Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
authors.affiliation: Department of Gynecology & Obstetrics, Centre Hospitalier Intercommunal de Poissy - Saint-Germain, Poissy, France.|Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
mesh_terms: D000328:Adult; D053159:Dysuria / Q000209:etiology* / Q000473:pathology; D004715:Endometriosis / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D059411:Lower Urinary Tract Symptoms / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D001743:Urinary Bladder / Q000473:pathology; D014563:Urodynamics
keywords: Endometriosis; Pelvic pain; Urinary dysfunction; Urodynamics