OC22.01: Transvaginal sonography‐based minimal invasive surgery for urinary tract endometriosis: test accuracy and outcomes

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To evaluate the accuracy of TVS for preoperative detection of bladder endometriosis (BE) and to describe TVS-based surgical outcomes of women undergoing laparoscopic procedures for UTE including BE and/ or hydronephrosis (HN). Retrospective cohort study of patients with suspected deep infiltrating endometriosis (DIE) as demonstrated by TVS underwent radical laparoscopic resection, which consisted of laparoscopic partial cystectomy (PC), ureterolysis (UL), ureteric end-to-end anastomosis (UEEA) or ureteroneocystostomy (UNC) at our department. Out of 207 patients with DIE, 43 exhibited UTE consisting of 25 patients with BE and 20 women with solitary or additional HN. Sensitivity, specificity, positive and negative predictive values and likelihood ratios for TVS regarding BE were 96%, 99%, 96%, 99%; 174,7 (24.7-1235.7 95% CI) and 0.04 (0.01-0.27 95% CI). All women with BE underwent PC. In cases of HN, 14 conservative ULs, 3 UEEAs and 3 UCNs were performed. Thirteen women with concomitant DIE of the rectum also underwent bowel resection. Laparoscopic surgery was feasible in 41/43 (conversion rate 5%) women with UTE. Median duration of surgery was 200 minutes, median blood loss 1.6 g/d with a median hospital stay of 8.6 days. We observed 3 complications according to Clavien-Dindo III including 1 leak following UEEA, 1 re-stenosis after UL and 1 subcutaneous hematoma. After a median follow-up of 29.5 months, we observed a significant decrease in dysmenorhhea (7.7 to 1.3; p=0.001), dyspareunia (3.8 to 1.1, p=0.001), dysuria (3.3 to 1.1; p=0.001) and increase in QoL (3.1 to 8.3; p=0.001). In subfertile women (23/43, 54%), the overall clinical pregnancy rate and life birth rate was 44% and 33%. TVS is highly accurate for presurgical diagnosis of BE. Laparoscopic surgery for BE and UTE including HN is safe, feasible and efficient regarding reduction of pain symptoms and treatment of subfertility with a low rate of complications.

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