To evaluate urinary symptoms before & after surgery for endometriosis & examine their correlation with confirmed urinary tract endometriosis, associated investigations & surgical management.

All patients undergoing total surgical excision of ureteric or bladder endometriosis over 53 months at one tertiary endometriosis centre were included. Electronic health records were reviewed to extract data regarding the rates of investigations for pelvic floor issues & post-op complications (graded using the Clavien-Dindo classification). Overall quality of life (QoL, as a 0-100 visual analogue scale), responses to EuroQol-5D-3L & responses to the BSGE Pelvic Pain Questionnaire were compared pre-op vs 6 months post op via paired Wilcoxon tests. Statistics are presented as percentages or median (95%CI).

In patients with bladder (14) & ureteric (37) endometriosis, 42.9% & 18.9% were investigated with UDS; 64.3% & 45.9% had cystoscopy for bladder symptoms. The predominant urinary symptom was bladder pain in 35.7% & 29.7% vs voiding dysfunction in 21.4% & 16.2%. Both improved post-operatively in ureteric patients (p<0.005), but only bladder pain improved in bladder patients. Post-op, 28.6% & 37.8% needed pelvic floor physiotherapy while 42.9% & 35.1% needed medication for urinary incontinence. 78.6% & 37.8% had specialist follow up with urology and/or urogynaecology. 7.1% and 2.7% had recurrent UTI post-op. One 4a complication (anastomotic bowel leak, return to theatre, ICU) occurred in one bladder patient; no grade 3 or 5 complications occurred. These likely reflect complexity of surgery rather than a risk from urinary tract endometriosis itself. The severity of bladder pain improved in both cohorts: 0 (95%CI: 0-3) post-op versus 7 (95%CI: 0-9) pre-op in bladder patients; 0 (95%CI: 0-2) post-op versus 3 (95%CI: 0-6) pre-op in ureteric patients (p<0.005 for both). Voiding dysfunction improved in ureteric patients (0 (95%CI: 0-3) post-op versus 0 (95%CI: 0-5) pre-op, p<0.005) but not in bladder patients (0 (95%CI: 0-6) post-op versus 0 (95%CI: 0-9) pre-op). QoL improved post-op in both cohorts: median scores of 68 (95%CI: 28-84) post-op versus 50 (95%CI: 14-60) pre-op in bladder patients; 80 (95%CI: 70-80) post-op versus 50 (95%CI: 46-60) pre-op in ureteric patients (p<0.005 for both). Both cohorts had improvements in EQ-5D-3L pain/discomfort (p<0.05), but no significant changes in anxiety/depression.

Urinary tract endometriosis confers a significant burden of urogynaecological symptoms, even following surgical excision, although symptoms do seem to improve overall. Voiding dysfunction did not significantly improve in bladder patients but the small sample size limits statistical power in this study. Based on preoperative bladder pain scores and a minimally clinically important improvement of 2/10 in scores, this study was powered at 29% for bladder patients and 74% for ureteric patients due to the rarity of urinary tract endometriosis cases over the 53 month study period.

Management of urinary tract endometriosis should be standardised with an MDT approach of urologists, urogynaecologists specialist nurses & pelvic floor physiotherapists to maximise the alleviation of symptoms post operatively.

Continence 19S (2026) 102692
DOI: 10.1016/j.cont.2026.102692