Effect of Surgical Treatment for Deep Infiltrating Endometriosis on Pelvic Floor Disorders: A Systematic Review with Meta-analysis

Abstract

Objectives To evaluate the impact of surgical treatment of deep infiltrative endometriosis (DIE) on pelvic floor dysfunction (urinary incontinence [UI], pelvic organ prolapse [POP], fecal incontinence [FI)] or constipation, and sexual function [dyspareunia]).

Data Source The present systematic review was performed in the PubMed database. For the selection of studies, articles should be published by January 5, 2021, without language restriction.

Study Selection Six randomized controlled studies that evaluated surgical treatment for DIE and the comparison of different surgical techniques were included.

Data Collection The studies were selected independently by title and abstract by two authors. Disagreements were resolved by a third author. All included studies were also evaluated according to the Cochrane risk of bias tool and the quality of the evidence was analyzed using the GRADE criteria. Subgroup analysis by different treatments and follow-up periods was also performed.

Results Six studies were included in the quantitative analysis. The risk of bias between studies showed an uncertain risk of bias for most studies, with concealment of allocation being the least reported category. The quality of the evidence was considered low. High heterogeneity was found between the studies. No study has evaluated UI or POP comparatively before and after surgery.

Conclusion Dyspareunia and FI have improved after the surgical procedure, but it was not possible to demonstrate which surgical technique was related to these outcomes as there was surgical heterogeneity. This diversity was found across data, with the recommendation of future prospective studies addressing pelvic floor disorders with DIE.

Resumo

Objetivos Avaliar o impacto do tratamento cirúrgico para endometriose infiltrante profunda (EIP) nas disfunções do assoalho pélvico (incontinência urinária [IU], prolapso de órgãos pélvicos [POP], incontinência fecal [IF] ou constipação e função sexual [dispareunia]).

Fonte de Dados A presente revisão sistemática foi realizada na base de dados PubMed. Para a seleção dos estudos, os artigos deveriam ser publicados até 5 de janeiro de 2021, sem restrição de idioma.

Seleção dos Estudos Foram incluídos seis estudos randomizados e controlados que avaliaram o tratamento cirúrgico para EIP e a comparação de diferentes técnicas cirúrgicas.

Coleta de Dados Os estudos foram selecionados de forma independente por título e resumo por dois autores. As discordâncias foram avaliadas por um terceiro autor. Todos os estudos incluídos foram avaliados de acordo com a ferramenta Cochrane de risco de viés e a qualidade de evidência foi analisada usando os critérios GRADE. A análise de subgrupo por diferentes tratamentos e períodos de acompanhamento também foi realizada.

Resultados Seis estudos foram incluídos na análise quantitativa. O risco de viés mostrou um risco incerto de viés para a maioria dos estudos, sendo a ocultação da alocação a categoria menos relatada. A qualidade de evidência foi considerada baixa. Alta heterogeneidade foi encontrada entre os estudos. Nenhum estudo avaliou a IU ou o POP comparativamente antes e após a cirurgia.

Conclusão A dispareunia e a IF melhoraram após o procedimento cirúrgico, mas não foi possível demonstrar qual técnica cirúrgica esteve relacionada a estes desfechos, pois houve heterogeneidade cirúrgica. Esta diversidade foi encontrada nos dados, com a recomendação de estudos prospectivos futuros abordando distúrbios do assoalho pélvico com EIP.

Keywords

systematic review - endometriosis - fecal incontinence - urinary incontinence - pelvic floor

Palavras-chave

revisão sistemática - endometriose - incontinência fecal - incontinência urinária - assoalho pélvico

Publication History

Received: 02 April 2021

Accepted: 03 November 2021

Article published online:
17 February 2022

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