Voiding dysfunction after surgery for deep infiltrating endometriosis : Prediction

robotic surgery recovery

After extensive pelvic surgery, such as that sometimes necessary for deep infiltrating endometriosis, the bladder and its nerves can be inflamed or irritated enough to temporarily stop working.  This sometimes means you have to wear a catheter for a few days to a week.  Predicting who might need this helps in getting ready for recovery.  The following study addressed this and found that prediction is possible, even though in the end it depends on how extensive the surgery is.  This part is not always predictable.  At the GO Institute, we individualize care and with minimally invasive robotic surgery, the inflammation and trauma to the bladder area are minimized.

“In this study, 198 women with deep infiltrating endometriosis in the posterior compartment who underwent surgery and a postoperative bladder scan.

Measurements and main results

After surgery, 41% of patients initially experienced voiding dysfunction (defined as >100ml PVR at second bladder scan). The number decreased to 11% by the time of hospital discharge. Among those with a need for self-catheterization after discharge(n=17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine of <100 ml. The preoperative presence of deep infiltrating endometriosis nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = 0.001). The hazard ratio for elevated residual urine was highest when the disease stage was B3 (HR 6.43; CI, 2.3-18.2; p < 0.001), describing a nodule diameter of > 3 cm in lateral distension. ROC curve analyses showed that a first residual urine volume > 220 ml has a good predictive value for the risk of intermittent self-catheterization (AUC 0.893, p <0.001).


Postoperative voiding dysfunction is frequent; fortunately, in most cases the problem is temporary. When deep infiltrating endometriosis with an ENZIAN classification B is noted intraoperatively and most of all, when the diameter of the lesion is greater than 3 cm, a higher risk of postoperative voiding dysfunction is to be expected.”

At the GO Institute, Dr. Vasilev performs multiple minimally invasive robotically enhanced surgeries of extensive complexity every week for endometriosis and cancer.  Our rate of voiding dysfunction is lower than average and in the vast majority of cases, using a catheter is rare and nowhere near the 41% in this study.  This may or may not be due to less tissue trauma and more precision from robotic surgery vs. laparoscopic surgery.

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