810 844
The main explanation for the lack of guidelines reported
[1]is that the pathology is rare, so studies report only small
series and thus the level of evidence is low. It is necessary to
conduct multicenter observational studies in referral
centers that group all their cases together
[7]. Large cohorts
of patients will help to answer some of the above questions,
especially those concerning surgical strategy. Finally, ran-
domized controlled trials comparing medical and surgical
treatments will make it possible to determine the benefit-to-
risk ratio for surgical resection compared to medical
treatment
[1_TD$DIFF]
only, whether in a pain or infertility setting.
Conflicts of interest:
Arnaud Fauconnier has received funding from Ipsen
for a research program on endometriosis and pelvic pain symptoms.
Gabrielle Aubry and Xavier Fritel have nothing to disclose.
References
[1]
Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Vigano` P, Vercellini P. Bladder endometriosis: a systematic review on pathogenesis, diagnosis, treatment, impact on fertility, and risk of malignant transformation. Eur Urol 2017;71:790–807.[2]
Panel P, Huchon C, Estrade-Huchon S, Le Tohic A, Fritel X, Faucon- nier A. Bladder symptoms and urodynamic observations of patients with endometriosis confirmed by laparoscopy. Int Urogynecol J 2016;27:445–51.[3]
Stratton P. The association of clinical symptoms with deep infiltrating endometriosis: the importance of the preoperative clin- ical assessment. Hum Reprod 2014;29:1627–8.[4]
Berkley KJ, Rapkin AJ, Papka RE. The pains of endometriosis. Science 2005;308:1587–9.
[5]
Chapron C, Dubuisson JB, Chopin N, et al. Deep pelvic endometri- osis: management and proposal for a ‘‘surgical classification’’. Gynecol Obstet Fertil 2003;31:197–206.[6]
Brosens IA. Endometriosis—a disease because it is characterized by bleeding. Am J Obstet Gynecol 1997;176:263–7.[7] Roman H. FRIENDS collaborative group. A national snapshot of the
surgical management of deep infiltrating endometriosis of the
rectum and colon in France in 2015: a multicenter series of
1,135 cases. J Gynecol Obstet Reprod Biol. In press,
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