Objective To identify phenotypes of pain in patients with endometriosis and to investigate their associations with predictors and quality of life (QoL). Design Population-based study. Setting A referral university center in Quebec City, Canada. Population or Sample A total of 352 patients aged 18‒50 years and diagnosed with endometriosis. Methods Latent class analysis (LCA) was used to identify pain phenotypes. To assess the associations, the three-step approach of LCA was applied. Main Outcome Measures Pain phenotypes, predictors of pain phenotypes, QoL. Results A total of 352 patients were included in the analyses. The diagnosis of endometriosis was either based on histology (N=135), imaging (N=106) or clinical presentation (N=111). The optimal model identified two distinct and homogeneous phenotypes of patients with endometriosis. The two groups had distinct clinical presentations, one with more severe and frequent pain symptoms and poorer quality of life (54%); the other with mild and less frequent pain symptoms (46%). Predictors of a high pain phenotype were a previous treatment failure, use of pain killers, a family history of endometriosis, a low annual family income, and pain comorbidities such as painful bladder, fibromyalgia, migraines, low back pain, irritable bowel syndrome, anxiety, and depression or mood disorders. The presence of endometrioma was predictive of the low pain phenotype. Phenotype membership was associated with distinct quality of life profiles (p<0.001). Conclusion Patients with endometriosis and pelvic pain can be grouped into two distinct and homogeneous phenotypes. Phenotypes membership correlates with quality of life and can be predicted with the patients’ characteristics. These findings will need to be validated in other populations and may inform the development of more specialized or personalized interventions based on the pain phenotypes.

Background: Mechanical bowel preparation before gynecologic surgeries has been administered for decades but its use is controversial today. Objectives: To assess the efficacy and tolerance of mechanical bowel preparation before benign laparoscopic or vaginal gynecologic surgeries. Search strategy: MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Sciences published up to December 2021. Selection criteria: Randomized clinical trials in any language comparing mechanical bowel preparation before laparoscopic and vaginal gynecologic surgeries with no preparation were included. Data collection and analysis: Two reviewers independently screened and extracted data from selected articles and assessed the risk of bias. Surgeon findings, operative outcomes and patient’s pre-operative symptoms and satisfaction were collected. Main results: Twelve studies (1715 patients) of the 925 records screened were included. No significant differences were observed on surgical field view (RR=1.01, 95%CI 0.97-1.05, p=0.66, I 2=0%); bowel handling (RR=1.01, 95%CI 0.95-1.08, p=0.78, I 2=67%). There were no statistically significant differences in peri-operative findings. Mechanical bowel preparation was associated with increased pain (MD=11.62[2.80-20.44], I 2=76, p=0.01); weakness (MD=10.73[0.60-20.87], I 2=94, p=0.04); hunger (MD=17.52[8.04-27.00], I 2=83, p=0.0003); insomnia (MD=10.13[0.57-19.68], I 2=82, p=0.04); and lower satisfaction (RR=0.68 95%CI 0.53-0.87, I 2=76%, p=0.002). Conclusion: In view of the adverse effects induced by mechanical bowel preparation and the lack of any surgical benefit, the routine its use prior to benign gynecological surgeries should be abandoned. Funding: This work was granted by the French network of University Hospitals HUGO and Fonds de recherche du Québec-Santé.