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Roditis A, Florin M, Rousset P, Touboul C, Bendifallah S, Bazot M, Thomassin-Naggara I. Accuracy of combined physical examination, transvaginal ultrasonography, and magnetic resonance imaging to diagnose deep endometriosis. Fertil Steril 2022; 119:634-643. [PMID: 36563836 DOI: 10.1016/j.fertnstert.2022.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the ability of physical examination (PE), transvaginal ultrasonography (TVUS), and magnetic resonance imaging (MRI) alone and combined to diagnose deep infiltrating endometriosis (DIE). DESIGN We retrospectively queried our pelvic MRI database to identify women who underwent PE, TVUS, and pelvic MRI for DIE up to 12 months before surgery between January 1, 2016 and August 31, 2020. The presence of uterosacral ligaments (USL), vaginal, rectosigmoid (RS), parametrial, or sacrorectogenital septum (lateral) DIE shown by PE, TVUS, and MRI were correlated with surgical and histological findings. SETTING Academic hospital. PATIENT(S) We included 178 patients. INTERVENTION(S) Clinical and imaging evaluation of women who were diagnosed at surgery with deep pelvic endometriosis. MAIN OUTCOME MEASURE(S) The sensitivity, specificity, positive and negative predictive values, and accuracy of each technique separately and combined were assessed for each location. When the 3 techniques were combined, 2 models were tested as follows: all 3 techniques positive and concordant; and ≥2 techniques positive and concordant. RESULT(S) The prevalence of USL, vaginal, RS, and lateral DIE were 94.4%, 20.2%, 34.3%, and 32.6%, respectively. In addition, MRI was more sensitive than PE, TVUS or any combination to detect DIE. Moreover, MRI and model B were the most accurate for detecting USL and RS locations with an accuracy of 90.4% and 82.6%, a sensitivity of 91.1% and 50%, and a specificity of 77.8% and 90.9%, respectively. Model B was the most accurate for the vaginal location with an accuracy, sensitivity, and specificity of 82.6%, 50%, and 90.9%, respectively. Finally, MRI was more accurate than any combination for identifying a lateral location with an accuracy, sensitivity, and specificity of 75.1%, 36%, and 93.8%, respectively. CONCLUSION(S) A combination of PE, TVUS, and MRI was more accurate than each technique separately to diagnose DIE because of the equally high sensitivity of each, as well as the high specificity of PE and TVUS.
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Affiliation(s)
- Alexis Roditis
- APHP Sorbonne Université, Hopital Tenon Service d'Imagerie Radiologiques et interventionnelles spécialisées (IRIS), Paris, France.
| | - Marie Florin
- APHP Sorbonne Université, Hopital Tenon Service d'Imagerie Radiologiques et interventionnelles spécialisées (IRIS), Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Claude Bernard University, Lyon, France
| | - Cyril Touboul
- APHP Sorbonne Université, Hopital Tenon Service de gynécologie et obstétrique, Paris, France
| | - Sofiane Bendifallah
- APHP Sorbonne Université, Hopital Tenon Service de gynécologie et obstétrique, Paris, France
| | - Marc Bazot
- APHP Sorbonne Université, Hopital Tenon Service d'Imagerie Radiologiques et interventionnelles spécialisées (IRIS), Paris, France
| | - Isabelle Thomassin-Naggara
- APHP Sorbonne Université, Hopital Tenon Service d'Imagerie Radiologiques et interventionnelles spécialisées (IRIS), Paris, France
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Tomasi MC, Ribeiro PAA, Farah D, Vidoto Cervantes G, Nicola ALD, Abdalla-Ribeiro HS. Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1294-1302. [PMID: 36252916 DOI: 10.1016/j.jmig.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This systematic review aimed to review all the available evidence regarding bladder endometriosis (BE) surgical techniques, resolution of symptoms, and nodule size. DATA SOURCES We conducted systematic searches in PubMed MEDLINE, Embase, Latin American and Caribbean Centre on Health Sciences Information, Cochrane Library, and Web of Science databases from inception to December 2021. METHODS OF STUDY SELECTION Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search yielded 1279 articles. Two reviewers independently screened abstracts and reviewed full-text articles to meet the eligibility criteria: women diagnosed as having BE, treated surgically to remove the BE nodule, and reported of the nodule size and/or symptoms after the surgery. We included 28 studies, which mainly were case reports and case series. TABULATION, INTEGRATION, AND RESULTS The following information was extracted from the included studies: author, country, publication year, study design, number of patients, age, surgery performed, follow-up time, operation time, nodule location, nodule size, and postsurgical symptoms. Patients' ages range from 26 to 44 years and most women were nulliparous. The BE nodule size ranged from 0.7 to 5.5 cm, and the most frequent location (63.57%) was the posterior wall. Dysuria was reported by 27.18% of women and generic lower urinary tract symptoms were reported by 27.95%. After surgery, the recurrence rate of urinary symptoms was 7.34%. Most studies performed a partial cystectomy to remove the nodule, showing that the disease affects the bladder mucosa frequently. CONCLUSION Surgical treatment with complete excision of BE lesion was shown to improve complaints of urinary symptoms in patients with BE. Given that most of the studies evaluated were descriptive, additional studies with a large sample population and a better level of evidence for this condition are needed.
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Affiliation(s)
- Mariana Carpenedo Tomasi
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro).
| | - Paulo Augusto Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, Sao Paulo, Brazil (Drs. Farah)
| | - Graziele Vidoto Cervantes
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Ana Luiza De Nicola
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Helizabet Salomão Abdalla-Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
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Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, Nisolle M, Roman H, Saridogan E, Tanos V, Tomassetti C, Ulrich UA, Vermeulen N, De Wilde RL. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020; 2020:hoaa002. [PMID: 32064361 PMCID: PMC7013143 DOI: 10.1093/hropen/hoaa002] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION How should surgery for endometriosis be performed? SUMMARY ANSWER This document provides recommendations covering technical aspects of different methods of surgery for deep endometriosis in women of reproductive age. WHAT IS KNOWN ALREADY Endometriosis is highly prevalent and often associated with severe symptoms. Yet compared to equally prevalent conditions, it is poorly understood and a challenge to manage. Previously published guidelines have provided recommendations for (surgical) treatment of deep endometriosis, based on the best available evidence, but without technical information and details on how to best perform such treatment in order to be effective and safe. STUDY DESIGN SIZE DURATION A working group of the European Society for Gynaecological Endoscopy (ESGE), ESHRE and the World Endometriosis Society (WES) collaborated on writing recommendations on the practical aspects of surgery for treatment of deep endometriosis. PARTICIPANTS/MATERIALS SETTING METHODS This document focused on surgery for deep endometriosis and is complementary to a previous document in this series focusing on endometrioma surgery. MAIN RESULTS AND THE ROLE OF CHANCE The document presents general recommendations for surgery for deep endometriosis, starting from preoperative assessments and first steps of surgery. Different approaches for surgical treatment are discussed and are respective of location and extent of disease; uterosacral ligaments and rectovaginal septum with or without involvement of the rectum, urinary tract or extrapelvic endometriosis. In addition, recommendations are provided on the treatment of frozen pelvis and on hysterectomy as a treatment for deep endometriosis. LIMITATIONS REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical expertise. Where available, references of relevant studies were added. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on management of endometriosis and the recommendations for surgical treatment of ovarian endometrioma. STUDY FUNDING/COMPETING INTERESTS The meetings of the working group were funded by ESGE, ESHRE and WES. Dr Roman reports personal fees from ETHICON, PLASMASURGICAL, OLYMPUS and NORDIC PHARMA, outside the submitted work; Dr Becker reports grants from Bayer AG, Volition Rx, MDNA Life Sciences and Roche Diagnostics Inc. and other relationships or activities from AbbVie Inc., and Myriad Inc, during the conduct of the study; Dr Tomassetti reports non-financial support from ESHRE, during the conduct of the study; and non-financial support and other were from Lumenis, Gedeon-Richter, Ferring Pharmaceuticals and Merck SA, outside the submitted work. The other authors had nothing to disclose. TRIAL REGISTRATION NUMBER na.
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Affiliation(s)
| | - Joerg Keckstein
- Endometriosis Centre Dres. Keckstein, Richard-Wagner Strasse 18, 9500 Villach, Austria
| | - Christian M Becker
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital Womens Centre, OX3 9DU Oxford, UK
| | - Michel Canis
- Department of Gynaecological Surgery, University Clermont Auvergne CHU, Estaing 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR Fribourg Hopital cantonal, 1708 Fribourg, Switzerland
| | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623 Thessaloniki, Greece
| | | | - Michelle Nisolle
- Hôpital de la Citadelle, Department of Obstetrics & Gynecology, 4000 Liège, Belgium
| | - Horace Roman
- Endometriosis Centre, Clinic Tivoli-Ducos, Bordeaux, France
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ertan Saridogan
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing Institute for Women’s Health, University College Hospital, NW1 2BU London, UK
| | - Vasilios Tanos
- Department of Obstetrics and Gynecology, Aretaeio Hospital, 2024 Nicosia, Cyprus
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, 3000 Leuven, Belgium
| | - Uwe A Ulrich
- Department of Obstetrics and Gynaecology, Martin Luther Hospital, 14193 Berlin, Germany
| | | | - Rudy Leon De Wilde
- University Hospital for Gynecology, Carl von Ossietzky Universitat Oldenburg, 26129 Oldenburg, Germany
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Performance of MRI for the detection of anterior pelvic endometriotic lesions. J Gynecol Obstet Hum Reprod 2018; 47:499-503. [PMID: 30273678 DOI: 10.1016/j.jogoh.2018.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the performance of MRI for the detection of anterior pelvic endometriotic lesions. MATERIALS AND METHODS We carried out a retrospective, single site, case-controlled study of patients who underwent surgery for endometriosis between March 2005 and December 2013. Laparoscopy was used to obtain the reference diagnosis of the endometriotic lesions. We age-matched patients with anterior endometriosis with those with isolated posterior endometriosis for reference. All of the pre-therapeutic MRI data were anonymized and blindly reread by two radiologists (junior and senior) twice. They assessed the overall presence of anterior lesions, those of the inter-vesicouterine space, the detrusor, the uterus, and posterior lesions. For each site, we calculated the sensitivity (Se) and specificity (Sp) for each reading compared to the reference, as well as the inter- and intra-operator variability using the Kappa coefficient (K) with its 95% confidence interval (95% CI). RESULTS During the study period, 256 patients underwent surgery for endometriosis: 22 presented with anterior endometriosis at surgery, and had had pre-preoperative imagery. We included 22 controls who had an isolated posterior lesion. For the overall detection of anterior lesions, the two radiologists had an identical Se of 77.3% (95% CI; 54.6-92.2). The Sp was 100% (95% CI; 82.4-100) for the junior, and 89.5% (95% CI; 66.9-98.7) for the senior radiologist. The area under the ROC curve was 0.89 (95% CI; 0.80-0.98) for the junior and 0.81 (95% CI; 0.68-0.93) for the senior radiologist. The intra-operator variability was low with almost perfect reproducibility for the overall detection of anterior lesions; k=0.90 (95% CI; 0.77-1) for the junior and k=0.85 (95% CI; 0.70-1) for the senior radiologist. For the various anterior sites, the junior radiologist had k values between 0.60 and 1, whereas those of the senior radiologist were between 0.87 and 1. For inter-operator reproducibility, there was modest agreement between the two radiologists, k=0.46 (95% CI; 0.19-0.73), for the overall detection of anterior lesions; k varied between 0.43 and 0.61, depending on the site. CONCLUSION Our results show that the characterization of anterior lesions by MRI is specific, but not very sensitive, with only moderate inter-operator reproducibility depending on the site. MRI can be used to diagnose anterior lesions, but cannot replace laparoscopy.
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Bolze PA, Paparel P, Golfier F. [Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29526792 DOI: 10.1016/j.gofs.2018.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Urinary tract involvement by endometriosis is reported in 1% of endometriosis patients (NP3). Consequences range from pelvic pain for bladder localizations to silent kidney loss in case of chronic ureteral obstruction (NP3). The feasibility of laparoscopic management was widely proven (NP3) and may reduce hospital stay length (NP4). Radical surgery with partial cystectomy for bladder localizations was shown to significantly and durably reduce pain symptoms with low risk of a severe postoperative complications (NP3). Medical hormonal treatment also shows short-term reduction of pain symptoms (NP4). Transureteral resection of bladder endometriosis nodule is not recommended (grade C) because of a high postoperative recurrence rate (NP4). Given a high risk of silent kidney loss, it is recommended that patients with ureteral involvement by endometriosis are managed by a multidisciplinary team considering urinary and potential extra-urinary localizations of endometriosis (grade C). No recommendation can be made on which technique to prefer between conservative (ureterolysis) or radical surgical techniques or on benefit and length of ureteral stents in case of ureteral involvement. Surgical management of bladder and ureteral localizations of endometriosis do not seem to be associated with altered or improved postoperative fertility (NP4). Since late postoperative ureteral anastomosis stenosis were reported with silent kidney loss, repeated postoperative imaging monitoring is justified (expert opinion).
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Affiliation(s)
- P-A Bolze
- Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie gynécologique et oncologique - obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - P Paparel
- Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie urologique, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite
| | - F Golfier
- Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie gynécologique et oncologique - obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Nyangoh Timoh K, Ballester M, Bendifallah S, Fauconnier A, Darai E. Fertility outcomes after laparoscopic partial bladder resection for deep endometriosis: Retrospective analysis from two expert centres and review of the literature. Eur J Obstet Gynecol Reprod Biol 2018; 220:12-17. [DOI: 10.1016/j.ejogrb.2017.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/09/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Gui B, Valentini AL, Ninivaggi V, Miccò M, Zecchi V, Grimaldi PP, Cambi F, Guido M, Bonomo L. Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis. Diagn Interv Radiol 2017; 23:272-281. [PMID: 28703103 PMCID: PMC5508950 DOI: 10.5152/dir.2017.16364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 01/07/2023]
Abstract
Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intralesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, pelvic peritoneum, uterosacral ligaments, and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter, and nerves. Moreover, rare extrapelvic endometriosis implants can be localized in the upper abdomen, subphrenic fold, or in the abdominal wall. Magnetic resonance imaging (MRI) represents a problem-solving tool among other imaging modalities. MRI is an advantageous technique, because of its multiplanarity, high contrast resolution, and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extrapelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should keep in mind these atypical localizations in patients with suspected endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.
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Affiliation(s)
- Benedetta Gui
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Anna Lia Valentini
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Valeria Ninivaggi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Maura Miccò
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Viola Zecchi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Pier Paolo Grimaldi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Francesco Cambi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Maurizio Guido
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Lorenzo Bonomo
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
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[Morbidity and functional long-term follow-up of patients with surgical treatment of urinary tract endometriosis]. ACTA ACUST UNITED AC 2017; 45:327-334. [PMID: 28552755 DOI: 10.1016/j.gofs.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/02/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess postoperative complications, improvement of pain symptoms and residual urinary functional symptoms after surgery for deep infiltrative endometriosis affecting ureter or bladder. METHODS Retrospective study of complications (Clavien-Dindo classification), pain (visual analog scale [VAS]) and urinary functional symptoms (Urinary Symptom Profile questionnaire [USP]) of patients surgically treated between 2007 and 2015 in University Hospitals of Lyon. RESULTS Among 31 patients with endometriosis involving the bladder, 83.9% had a partial cystectomy and 16.1% an extra-mucosal resection. Among patients (n=20) with ureteral involvement, 85% had ureterectomy with ureterocystoneostomy and 15% had only ureterolysis. Grade III postoperative complications occurred in 6% and 0% of patients with bladder or ureteral surgery, respectively and no grade IV or V complications were reported. Mean bladder VAS dropped from 5.3±4.2 to 0.3±0.9 after a follow-up of 42 months (P<0.0001). In patients with ureteral involvement, mean flank VAS dropped from 3.6 to 0.9 after a follow-up of 33 months (P<0.0005). Mean postoperative USP score for dysuria and detrusor overactivity were 1.35/9 and 2.48/21 in case of bladder involvement, and 1.10/9 and 2.15/21 in case of ureteral involvement. CONCLUSION Multidisciplinary surgical management of deep infiltrative endometriosis affecting urinary tract was associated to a low risk of severe postoperative complications and to a long-term significant improvement of pain symptoms without significant residual functional urinary symptoms.
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le Carpentier M, Merlot B, Bot Robin V, Rubod C, Collinet P. [Partial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy]. ACTA ACUST UNITED AC 2016; 44:315-21. [PMID: 27032760 DOI: 10.1016/j.gyobfe.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. METHODS A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. RESULTS We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. CONCLUSIONS Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications.
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Affiliation(s)
- M le Carpentier
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France.
| | - B Merlot
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - V Bot Robin
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - C Rubod
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - P Collinet
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
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Leroy A, Garabedian C, Fourquet T, Azaïs H, Merlot B, Collinet P, Rubod C. [Pictures balance for optimal surgical management of pelvic endometriosis. Imaging and surgery of endometriosis]. ACTA ACUST UNITED AC 2016; 45:214-25. [PMID: 26874665 DOI: 10.1016/j.jgyn.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/24/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
Endometriosis is a frequent benign pathology that is found in 10-15% of women and in 20% of infertile women. It has an impact on fertility, but also in everyday life. If medical treatment fails, surgical treatment can be offered to the patient. To provide adequate treatment and give clearer information to patients, it seems essential to achieve an optimal preoperative imaging assessment. Thus, the aim of this work is to define the information expected by the surgeon and the indications of each imaging test for each compartment of the pelvis, allowing an ideal surgical management of pelvic endometriosis. We will not discuss imaging techniques' principles and we will not develop the indications and surgical techniques.
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Affiliation(s)
- A Leroy
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France.
| | - C Garabedian
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France.
| | - T Fourquet
- Centre d'imagerie de la femme, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59037 Lille cedex, France
| | - H Azaïs
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| | - B Merlot
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| | - C Rubod
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
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Fadhlaoui A, Gillon T, Lebbi I, Bouquet de Jolinière J, Feki A. Endometriosis and Vesico-Sphincteral Disorders. Front Surg 2015; 2:23. [PMID: 26157800 PMCID: PMC4476201 DOI: 10.3389/fsurg.2015.00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this mini review is to determine the relationship between endometriosis and urinary tract symptoms and to investigate the consequences of surgical treatment of mild to severe endometriosis, especially deep lesions, on the vesico-sphincteral function (lower urinary tract function). Materials and methods We performed a literature review by searching the MEDLINE database for articles published between 2000 and 2014, limiting the searches to the words: urinary tract, vesico-sphincteral, dysfunction, endometriosis, symptoms, and surgery. Results The incidence of vesico-sphincteral symptoms in endometriosis varies from 3.4 up to 15.4%. The frequency of such symptoms seems to be under estimated because of a lack of specific questionnaire including urinary symptoms. Urodynamic evaluation could help to detect unsuspected abnormalities. It seems that endometriosis surgery (particularly deep infiltrating lesions) is a purveyor of de novo urinary dysfunction, with an incidence varying from 6.8 up to 17.5%. Nerve sparing processes such as neuro-navigators or neuro-stimulators seem to be promising techniques to avoid postoperative urinary tract dysfunction. Conclusion A precise anamnesis and the use of specific validated questionnaires (IPSS and BFLUTS) improve the screening of vesico-sphincteral symptoms in case of endometriosis. No recommendation can be found in the literature about the place of urodynamic evaluation. Most publications lack of proof and therefore do not allow making recommendations about optimal treatment of endometriotic lesions to avoid urinary tract disorders.
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Affiliation(s)
- Anis Fadhlaoui
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland ; Service de Gynécologie Obstetrique et de Médecine de la reproduction de l'Hôpital Aziza Othmana , Tunis , Tunisia ; Faculté de Médecine de Tunis , Tunis , Tunisia
| | - Tessa Gillon
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
| | - Issam Lebbi
- Obstetric Gynecology and Fertility Private Clinic, Dream Center , Tunis , Tunisia
| | | | - Anis Feki
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
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Angioni S, Cela V, Sedda F, Stochino Loi E, Cofelice V, Pontis A, Melis GB. Focusing on surgery results in infertile patients with deep endometriosis. Gynecol Endocrinol 2015; 31:595-8. [PMID: 26172932 DOI: 10.3109/09513590.2015.1062868] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Infertility is a common problem in patients with endometriosis and the involved mechanisms are still not completely known. The management of infertility in endometriosis patients includes surgery as well as assisted reproductive technology. Laparoscopic surgery has shown better results in infertility patients with endometriosis in comparison to laparotomy procedures. Laparoscopic surgery has proposed benefits in both minimal to moderate diseases. However, while there may be some benefits with severe diseases, there is still not enough evidence to recommend laparoscopic surgery as the recommended surgery when the main goal is to obtain fertility. We performed a MEDLINE search for articles on fertility in women with deep infiltrating endometriosis (DIE) published between 1990 and April 2015 using the following keywords: "endometriosis", "deep infiltrative endometriosis", "infertility", "fertility after surgery", "laparoscopy surgery", "laparotomy", "pregnancy", "fertility outcome", "bladder endometriosis", and "ureteral endometriosis". The aim of this review was to analyze the results of available clinical studies (randomized controlled or not controlled studies; retrospective cohort studies; or case-control and prospective studies) and guidelines on surgical treatment of infertile endometriosis patients, and pregnancy outcomes after surgery.
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Affiliation(s)
- Stefano Angioni
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - Vito Cela
- b Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Pisa , Italy , and
| | - Federica Sedda
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - Emanuela Stochino Loi
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - Vito Cofelice
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | | | - Gian Benedetto Melis
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
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13
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Urinary endometriosis: MR imaging appearance with surgical and histological correlations. Diagn Interv Imaging 2014; 96:373-81. [PMID: 25556292 DOI: 10.1016/j.diii.2014.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The goals of the study were to describe the MR imaging features of endometriosis of the urinary tract and identify those that suggest intrinsic involvement of ureteric wall. MATERIALS AND METHODS Thirty-five women with proven urinary tract endometriosis and who had preoperative MR imaging between 2001 and 2011 were included retrospectively. MR images were intrepreted by one junior and one senior radiologists. To characterize the intrinsic parietal involvement, the ureteric circumference involved by the lesion of endometriosis was noted. RESULTS Thirty-eight ureteric and 13 bladder lesions were analyzed. They were found in association in nine women. Ureteric lesions were bilateral in seven women. Of the 38 ureteric lesions, 27 were extrinsic and 11 intrinsic at histopathological analysis. Sixteen women with extrinsic lesions and 10 with intrinsic ones were correctly identified on MR imaging. When the ureter was included less than 360° in the lesion, extrinsic involvement was confirmed in 80% of cases. CONCLUSION MR imaging appears to be more sensitive (91%vs 82%) but less specific (59% vs 67%) than surgery for the diagnosis of intrinsic form of ureteric location.
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Hormonal treatment for severe hydronephrosis caused by bladder endometriosis. Case Rep Urol 2014; 2014:891295. [PMID: 25506035 PMCID: PMC4251884 DOI: 10.1155/2014/891295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/06/2014] [Indexed: 02/01/2023] Open
Abstract
The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydronephrosis and bladder endometriosis was determined in the etiology. After the patient was pathologically diagnosed, Levonorgestrel-Releasing Intrauterine System (LNG-IUS) was administered to the uterine cavity. At the 12-month follow-up, endometriosis was not observed in the cystoscopy and symptoms had completely regressed. Hydronephrosis may be observed after exposure of the ureter, and silent renal function loss may develop in patients suffering from endometriosis with bladder involvement. For patients with moderate or severe hydronephrosis associated with bladder endometriosis, LNG-IUS application may be separately and successfully used after conservative surgery.
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Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, Rigatti P, Colombo R. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int 2012; 89:249-58. [PMID: 22813980 DOI: 10.1159/000339519] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up. The surgical urological treatment might lead to good results. STUDY OBJECTIVE To define the state of the art in the diagnosis and treatment of bladder endometriosis. METHODS We performed a literature review by searching the MEDLINE database for articles published between 1996 and 2011, limiting the searches to the words: urinary tract endometriosis, bladderendometriosis, symptoms, diagnosis and treatment. RESULTS Deep pelvic endometriosis usually involves the urinary system, with the bladder being affected in 85% of cases. The diagnosis has to be considered as a step-by-step procedure. Currently, the treatment is usually surgical, consisting of either transurethral resection or partial cystectomy, and eventually associated with hormonal therapy. The hormonal therapy alone counteracts only the stimulus of endometriotic tissue proliferation, with no effects on the scarring caused by this tissue. The overall recurrence rate is about 30% for combined therapies and about 35% for the hormonal treatment alone. CONCLUSIONS The bladder is the most common affected site in urinary tract endometriosis. Most of the time, this condition is diagnosed because of the complaint of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis: a close collaboration between the gynecologist and the urologist is advisable, especially in highly specialized centers. The surgical urological treatment might lead to good results in terms of patients' compliance and prognosis.
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Affiliation(s)
- Carmen Maccagnano
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.
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Abstract
Endometriosis usually affects reproductive-aged women and can be responsible for pain symptoms and infertility. Deep infiltrating endometriosis may involve the uterine ligaments (utero-sacral and/or round ligaments), the retrocervical area, the rectovaginal septum, the rectum, the vagina, and the bladder. The pre-operative assessment of such lesions is required to plan full surgical excision of the disease. Endometriotic lesions have some typical imaging patterns on transvaginal ultrasound and magnetic resonance imaging enabling pre-operative mapping of the disease. In this paper the authors report the imaging features of deep infiltrating endometriosis and the laparoscopic correlation of such lesions.
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Coutinho A, Bittencourt LK, Pires CE, Junqueira F, de Oliveira Lima CMA, Coutinho E, Domingues MA, Domingues RC, Marchiori E. MR Imaging in Deep Pelvic Endometriosis: A Pictorial Essay. Radiographics 2011; 31:549-67. [DOI: 10.1148/rg.312105144] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kovoor E, Nassif J, Miranda-Mendoza I, Wattiez A. Endometriosis of Bladder: Outcomes after Laparoscopic Surgery. J Minim Invasive Gynecol 2010; 17:600-4. [DOI: 10.1016/j.jmig.2010.05.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 05/11/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
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Novellas S, Chassang M, Bouaziz J, Delotte J, Toullalan O, Chevallier EP. Anterior pelvic endometriosis: MRI features. ACTA ACUST UNITED AC 2010; 35:742-9. [DOI: 10.1007/s00261-010-9600-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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