Surgery for Deep Infiltrating Endometriosis

DIE with bowel, bladder, or ureteral involvement requires multidisciplinary minimally invasive surgery.

Written by: Saygı Hospital Health Guide Editorial Board

Last updated: June 10, 2026

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Surgery for Deep Infiltrating Endometriosis?

DIE affects 1-2% of women and represents the most severe form of endometriosis. Typical sites include the rectovaginal space, uterosacral ligaments, bowel (rectosigmoid), bladder, and ureter.

Diagnosis relies on dedicated DIE-protocol transvaginal ultrasound, pelvic MRI, and when needed, colonoscopy or cystoscopy. Detailed preoperative mapping is essential for a multidisciplinary approach.

Treatment may require nodulectomy, shaving, discoid resection, or segmental bowel resection. Ureteric involvement is managed with ureterolysis, stenting, or neocystostomy. Collaboration among gynecology, colorectal surgery, and urology is mandatory.

Symptoms

Severe dysmenorrhea (VAS ≥8)

Deep dyspareunia

Chronic pelvic pain

Dyschezia (painful defecation)

Dysuria and cyclic hematuria

Tenesmus and rectal bleeding

Risk Factors

Long-standing endometriosis

Early menarche

Nulliparity

Family history of DIE

Late menopause

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

Persistent severe dysmenorrhea
New-onset deep dyspareunia
Bowel or bladder symptoms
Infertility evaluation

Treatment Methods

Transvaginal ultrasound with DIE protocol

Pelvic MRI mapping

Laparoscopic nodule excision or shaving

Segmental rectosigmoid resection

Ureterolysis or neocystostomy

Postoperative GnRH analogue and dienogest

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.