title: History of Uterine Surgery Is Not Associated With an Increased Severity of Bladder Deep Endometriosis.
abstract: To analyze whether a history of uterine surgery correlates with disease severity in patients with bladder deep infiltrating endometriosis (DIE).
  
  
  
  This was an observational, cross-sectional study using data collected prospectively (Canadian Task Force classification II-2).
  
  
  
  A single university tertiary referral center.
  
  
  
  We included all nonpregnant women younger than age 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient, a standardized questionnaire was completed during a face-to-face interview that was conducted by the surgeon in the month preceding the surgery.
  
  
  
  One hundred seven women with histologically proven bladder DIE were enrolled in this study. For the purpose of the study, the women were assigned to 2 groups before surgery: a study group that included women with a history of a scarred uterus (SU) (SU+, n = 16) and a control group that included women without SU (SU-, n = 99). Both groups were compared in terms of their general characteristics, medical histories, surgical findings, and the severity of the disease.
  
  
  
  Patient age and body mass index were higher for the SU+ group as compared to the SU- group (37.9 ± 5.6 vs 32.2 ± 4.7, p < .01, and 24.7 ± 4.9 vs 21.9 ± 2.9, p = .03, respectively). Preoperative painful symptom scores did not differ between the 2 groups. No significant difference was observed in the rates of history for surgery for endometriosis (n = 11 [68.7%] vs n = 49 [53.8], p = .27). Comparison of the anatomic distribution of the lesions did not reveal a significant difference. The total American Society for Reproductive Medicine score did not differ between the groups (32.0 ± 34.4 vs 35.5 ± 34.5, p = .71). The incidence rate of isolated bladder DIE did not differ between the 2 study groups (n = 6 [37.5%] vs n = 40 [43.9%], p = .79).
  
  
  
  SU before surgery for endometriosis was observed in 14.9% of cases of bladder DIE; however, this was not related to an increased severity of the disease. This observational study hence does not appear to support the pathophysiologic hypothesis of a transmyometrial source for bladder DIE.
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Stress Oxydant, Prolifération Cellulaire et Inflammation, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Marcellin
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Morin
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Stress Oxydant, Prolifération Cellulaire et Inflammation, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Santulli
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Stress Oxydant, Prolifération Cellulaire et Inflammation, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Marzouk
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bourret
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Department of Digestive and Endocrine Surgery, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe Stress Oxydant, Prolifération Cellulaire et Inflammation, Département Développement, Reproduction, Cancer, Inserm U1016, Faculté de Médecine, AP-HP, HUPC, CHU Cochin, Paris, France. Electronic address: charles.chapron@cch.aphp.fr.
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005602:France; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007407:Interviews as Topic; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000473:pathology; D014591:Uterine Diseases / Q000601:surgery*
keywords: Bladder endometriosis; Uterine surgery