LAUSR

OBJECTIVE Surgical management of deep endometriosis is associated with a high incidence of lower urinary tract dysfunction. The aim of the current systematic review and meta-analysis was to assess the rates of voiding dysfunction according to colorectal shaving, discoid excision and segmental resection for deep endometriosis. DATA SOURCES We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for colorectal endometriosis and voiding dysfunction were combined and restricted to the French and English languages. The final search was performed on August 28, 2019. The outcome measured was the occurrence of postoperative voiding dysfunction. METHODS OF STUDY SELECTION Study Quality Assessment Tools were used to assess the quality of included studies. Studies rated as good and fair were included. Two reviewers independently assessed the quality of each included study, discrepancies were discussed and, if consensus was not reached, a third reviewer was consulted. TABULATION, INTEGRATION AND RESULTS Out of 201 relevant published reports, 51 studies were ultimately reviewed systematically and 13 were included in the meta-analysis. Rectal shaving was statistically less associated with postoperative voiding dysfunction than segmental colorectal resection (OR 0.34, 95% CI 0.18-0.63, I2= 0%, p=0.0006) or discoid excision (OR 0.22, 95% CI 0.09-0.51, I2 = 0%, p=0.0004). No significant difference was noted when comparing discoid excision and segmental colorectal resection (OR 0.74, 95% CI 0.32-1.69, I2= 29%, p=0.47). Similarly, rectal shaving was associated with a lower risk of self-catheterization >1 month compared with segmental colorectal resection (OR 0.3, 95% CI 0.14-0.66, I2= 0%, p=0.003). This outcome was no longer significant when comparing discoid excision and segmental colorectal resection (OR 0.72, 95% CI 0.4-1.31, I2 = 63%, p=0.28). CONCLUSION Colorectal surgery for endometriosis has a significant impact on urinary function regardless of the technique. However, rectal shaving causes less postoperative voiding dysfunction than discoid excision or segmental resection.