A narrative review on the impact of nerve sparing surgery on urinary function in pelvic surgery for endometriosis

Abstract

: Endometriosis is an all too common benign inflammatory condition that impacts the lives of countless women around the world. Not only is there typically a delay in diagnosis of this devastating condition, but women are often mismanaged until they reach a provider with expertise in the condition. Endometriosis can be associated with a multitude of different symptoms most common cyclical pelvic pain, painful intercourse, pain with urination or defecation, and chronic pelvic pain. First line therapy for this condition is often hormonal therapy, however, surgery may be indicated for the appropriate patient. Deeply infiltrating endometriosis is often refractory to medical therapy and usually surgery is the only reasonable treatment approach. Deeply infiltrating disease can involve sensory nerves in the pelvis believed to be attributed to many symptoms. Furthermore, inadvertent or unrecognized damage to these nerves during surgery can lead to many unwanted complications following surgery for endometriosis. Nerve sparing surgery for endometriosis has been well defined and is associated with improved functional outcomes for women. Appropriate training and understanding of pelvic neuroanatomy are needed to perform these nerve sparing procedures and this review serves to highlight the benefits of nerve sparing procedures on functional urinary outcomes following surgery.