Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis (DIE)

ABSTRACT Research Question To assess associations between preoperative symptoms in patients with deep infiltrating endometriosis (DIE) and intraoperatively determined disease extent described by the revised ENZIAN score. Design Retrospective data analysis of women who underwent surgery for DIE between 2014 and 2018 at the Department of Gynecology, Hospital St. John of God, Vienna (tertiary referral center for endometriosis). Results Data of 245 women were analysed. Statistically significant associations between involvement of ENZIAN compartment B (uterosacral ligaments, parametrium) and presence of dyspareunia (p=0.002), ENZIAN compartment C (rectum, sigmoid colon) and dyschezia (p s 0.334, p s 0.127, p=0.046). Severity of dysmenorrhea correlated with lesion size in ENZIAN compartment A (r s 0.244, p s 0.256, p s 0.161, p=0.012). Conclusion In contrast to previous studies evaluating disease extent based on the revised American Society for Reproductive Medicine (rASRM) score, disease localization and extent as described by the revised ENZIAN score was associated and correlated with presence and severity of different preoperative symptoms. These explorative findings suggest that it may be important to evaluate DIE extent using the revised ENZIAN score in addition to the rASRM score.