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Published in: Gynecological Surgery 4/2016

Open Access 01-11-2016 | Original Article

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

Authors: Liisu Saavalainen, Oskari Heikinheimo, Aila Tiitinen, Päivi Härkki

Published in: Gynecological Surgery | Issue 4/2016

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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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Metadata
Title
Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013
Authors
Liisu Saavalainen
Oskari Heikinheimo
Aila Tiitinen
Päivi Härkki
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
Gynecological Surgery / Issue 4/2016
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI
https://doi.org/10.1007/s10397-016-0958-0

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