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A Comparison of Pre- and Post-Operative Bladder/Bowel Symptoms Among Patients Undergoing Complete Surgical Endometriosis Resection
Rachael Mazzamurro-Romer, BA1, Chung Hwa YI, MD2, Veronica Triaca, MD2
1Geisel School of Medicine at Dartmouth, Hanover, NH; 2Concord Hospital, Concord, NH

Introduction/Background: We sought to determine the prevalence of bladder and bowel symptoms among patients presenting for surgical management of endometriosis and to assess the impact of complete laparoscopic endometriosis resection on those symptoms.
Methods: Retrospective chart review. Surgeries were performed by a single surgeon at one hospital from 1/2016-1/2018, with all patients receiving care at the hospitalís integrated pelvic medicine clinic. Patient-reported pre-operative symptoms were assessed for 59 cases. Post-operative symptom improvement was assessed for the 56 patients who presented for follow-up. Referral diagnoses/chief complaints at the time of initial presentation were assessed for the 46 patients without a prior biopsy-confirmed diagnosis of endometriosis.
Results: Average age at the time of surgery was 25 years (15-42). Based on referral diagnoses/chief complaints at the time of initial presentation: 69.6% of patients had exclusively gynecologic complaints, 21.7% had both gynecologic and urologic complaints, and 8.7% had exclusively urologic complaints. The most common presenting complaints were: pelvic pain (65.2%), dyspareunia (34.8%), endometriosis by history (23.9%), abdominal pain (23.9%), dysmenorrhea (19.6%), urinary frequency (15.2%), and dysuria (15.2%). Time from initial presentation to surgery was, on average, 185.6 days (13-1140) for the 71.7% of patients who presented to a gynecologist for their initial appointment, 255.8 days (55-1081) for the 13% who saw both a urologist and gynecologist at their initial visit, and 785 days (61-2753) for the 15.2% who presented to a urologist. At their pre-operative visit, 100% of patients endorsed pain symptoms, 72.9% bladder symptoms, and 44.1% bowel symptoms. The most common pre-operative symptoms were: dysmenorrhea (83.1%), dyspareunia (72.9%), pelvic pain (69.5%), urinary frequency (57.6%), urinary urgency (50.8%), and constipation (35.6%). 89.3% of patients with pre-operative pain symptoms, 53.7% with bladder symptoms, and 50% with bowel symptoms reported symptom improvement/resolution at their post-operative visit. Of patients with pathology-confirmed endometriosis, 91.1% had post-operative improvement in pain symptoms, 52.9% in bladder symptoms, and 55% in bowel symptoms; of patients with negative pathology, 80% had improvement in pain symptoms, 57.1% in bladder symptoms, and 25% in bowel symptoms.
Conclusions: Bladder/bowel symptoms are potential surrogate symptoms for endometriosis. Complete surgical resection of endometriosis results in improvement of pain, bladder, and bowel symptoms for the majority of patients.


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