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Grigoriadis G, Daniilidis A, Merlot B, Stratakis K, Dennis T, Crestani A, Chanavaz-Lacheray I, Roman H. Surgical treatment of deep endometriosis: Impact on spontaneous conception. Best Pract Res Clin Obstet Gynaecol 2024; 93:102455. [PMID: 38181664 DOI: 10.1016/j.bpobgyn.2024.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
Deep endometriosis (DE) is the most severe form of endometriosis and is commonly associated with infertility. Surgical treatment of DE appears to increase chances of spontaneous conception in appropriately selected patients wishing to conceive. Identifying, however, the exact impact of DE, and its surgical removal, on natural conception is highly challenging. The surgical approach should be favoured in symptomatic patients with pregnancy intention. Limited data from infertile patients suggest that outcomes may not differ from patients without known infertility. Complex DE surgery carries a risk of serious complications, therefore, it should be performed in centers of expertise. Such complications may, however, not have a significant negative impact on fertility outcomes, according to limited available data. Data on obstetric outcomes of spontaneous conceptions after DE surgery are too scarce. In asymptomatic, infertile patients the debate between primary surgery or Artifial Reproductive Technology is ongoing, until randomized studies report their results.
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Affiliation(s)
| | - Angelos Daniilidis
- 1st Department in Obstetrics and Gynecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643, Thessaloniki, Greece
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
| | - Konstantinos Stratakis
- 1st Surgical Department, Peripheral General Hospital Giorgos Gennimatas, 11527, Athens, Greece
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Isabella Chanavaz-Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark.
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Turco LC, Raimondo D, Raffone A, Raimondo I, Vargiu V, Raspollini A, Travaglino A, Tinelli R, Zanetti E, Ferrandina G, Seracchioli R, Casadio P, Scambia G, Cosentino F. Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study. Int J Gynaecol Obstet 2024; 164:550-556. [PMID: 37715533 DOI: 10.1002/ijgo.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To compare safety and effectiveness of two-different directions of suturing the posterior vaginal breach (horizontal [Ho] vs vertical [Ve]) in women undergoing recto-vaginal endometriosis (RVE) nodule resection. METHODS A multicenter, retrospective, observational, cohort study was performed including all women of reproductive age undergoing RVE nodule resection between March 2013 and December 2018 at our tertiary centers. Patients included in the present study were divided into two groups based on the direction in suturing the posterior vaginal fornix defect, for comparisons in terms of rate of postoperative complications, pain relief, pain and anatomical recurrence, and length of hospital stay. Univariate comparisons were performed adopting the t test or the Mann-Whitney test for continuous data and the chi-square test or the Fisher exact test for categorical data, with a significant P value set to <0.05. RESULTS A total of 101 women were included: 67 in the Ho-group and 34 in the Ve-group. The two groups did not significantly differ in length of hospital stay (6.7 ± 6.9 vs 6.6 ± 3.3 days; P = 0.95), overall postoperative complications (32.8% vs 14.7%; P = 0.05), pain recurrence (35.8% vs 26.5%; P = 0.34) and anatomical recurrence rate (19.4% vs 23.5%; P = 0.62). Conversely, grade III complications were significantly more common in the Ho-group than in the Ve-group (22.7% vs 20%, P = 0.009), while pain relief in terms of deep dyspareunia, dyschezia, dysuria and chronic pelvic pain was more consistent in the Ve-group patients (P = 0.04, 0.04, 0.05, 0.004, respectively). CONCLUSION In symptomatic women undergoing RVE nodule resection, Ho suturing of the vaginal breach appears more commonly associated with severe postoperative complications and a worse pain control.
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Affiliation(s)
- Luigi Carlo Turco
- Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Ivano Raimondo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy
| | - Virginia Vargiu
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, Antonio Perrino Hospital, Brindisi, Italy
| | - Enrico Zanetti
- Gynecology and Obstetrics Unit, University of Brescia, Italy
| | - Gabriella Ferrandina
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
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Crestani A, Bibaoune A, Le Gac M, Dabi Y, Kolanska K, Ferrier C, Bendifallah S, Touboul C, Darai E. Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery. J Robot Surg 2023; 17:2703-2710. [PMID: 37606871 DOI: 10.1007/s11701-023-01691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
The aim of this study was to analyze postoperative consumption of analgesics during hospitalization following colorectal surgery for endometriosis. We conducted a retrospective study at Tenon University Hospital, Paris, France from February 2019 to December 2021. One hundred sixty-two patients underwent colorectal surgery: eighty-nine (55%) by robotic and seventy-three (45%) by conventional laparoscopy. The type of procedure had an impact on acetaminophen and nefopam consumed per day: consumption for colorectal shaving, discoid resection, and segmental resection was, respectively, 2(0.5), 2.1(0.6), 2.4(0.6) g/day (p = 10-3), and 25(7), 30(14), 31(11) mg/day (p = 0.03). The total amount of tramadol consumed was greater following robotic surgery compared with conventional laparoscopy (322(222) mg vs 242(292) mg, p = 0.04). We observed a switch in analgesic consumption over the years: tramadol was used by 70% of patients in 2019 but only by 7.1% in 2021 (p < 10-3); conversely, ketoprofen was not used in 2019, but was consumed by 57% of patients in 2021 (p < 10-3). A history of abdominal surgery (OR = 0.37 (0.16-0.78, p = 0.011) and having surgery in 2020 rather than in 2019 (OR = 0.10 (0.04-0.24, p < 10-3)) and in 2021 than in 2019 (OR = 0.08 (0.03-0.20, p < 10-3)) were the only variables independently associated with the risk of opioid use. We found that neither clinical characteristics nor intraoperative findings had an impact on opioid consumption in this setting, and that it was possible to rapidly modify in-hospital analgesic consumption modalities by significantly reducing opioid consumption in favor of NSAIDS or nefopam.
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Affiliation(s)
- Adrien Crestani
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France.
| | - Amine Bibaoune
- Department of Pharmacy, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Marjolaine Le Gac
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Kamila Kolanska
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
- UMRS 938, Centre de Recherche Saint Antoine, Faculté de Médecine Sorbonne Université, 75012, Paris, France
| | - Clément Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
- Department of Pharmacy, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
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de Carvalho MDSR, Pellino G, Pereira AMG, Bray-Beraldo F, Lopes RGC, Di Saverio S. Prevalence of urinary dysfunction after minimally invasive surgery for deep rectosigmoid endometriosis. Langenbecks Arch Surg 2023; 408:83. [PMID: 36773124 DOI: 10.1007/s00423-023-02831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE This study aimed to assess the prevalence and progression of lower urinary tract symptoms following laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid and identify preoperative factors associated with worse postoperative outcomes. METHODS Prospective, observational study. SETTINGS single-center, referral hospital for endometriosis. Patients undergoing laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid colon between October 2016 and October 2018. MAIN OUTCOME MEASURES urinary function was assessed with the validated Portuguese language version of the International Prostate Symptom Score, which is also used in women. The score was collected before and after surgery. The Wilcoxon signed-rank test was used to compare pre and postoperative scores and the chi-square test compared symptoms categorized by severity. RESULTS Fifty-three patients were assessed and 44 were included. Concerning urinary symptoms after surgery, the irritative symptoms prevailed over the obstructive ones. Additionally, 58.8% and 54.5% of the women reported moderate or severe symptoms at pre and postoperative, respectively. In at least one questionnaire category, the postoperative questionnaire scores increased in ten (22.7%) participants. A statistically significant difference was found comparing the changes from absent/mild to moderate/severe IPSS categories (P = 0.039). No significant changes were identified in any of the International Prostate Symptom Score pre and postoperatively (P = 0.876). CONCLUSIONS There was a high prevalence of pre and postoperative urinary symptoms. Patients with preoperative moderate/severe International Prostate Symptom Score are at risk of persisting urinary dysfunction after surgery for rectosigmoid deep endometriosis.
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Affiliation(s)
- Mariana de Sousa Ribeiro de Carvalho
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Ana Maria Gomes Pereira
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil
| | - Fernando Bray-Beraldo
- Department of Digestive Surgery and Coloproctology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Reginaldo Guedes Coelho Lopes
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil
| | - Salomone Di Saverio
- Cambridge Endometriosis & Endoscopic Surgery Unit (CEESU) and Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
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de Rooij FPW, Ronkes BL, Groenman FA, Bouman MB, Nieuwenhuijzen JA, van Moorselaar RJA, Pigot GLS. The effect of colpectomy on lower urinary tract function in transgender men. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:510-518. [PMID: 37901055 PMCID: PMC10601515 DOI: 10.1080/26895269.2022.2136813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: In transgender men, effects of colpectomy on voiding function are unknown, except for the incidence rates of urinary tract infections and urinary retention. Aims: To provide insight into the effect of colpectomy on Lower Urinary Tract Function (LUTF) in transgender men. Methods: A retrospective chart review was conducted among transgender men who underwent colpectomy between January 2018 and October 2020. Primary outcomes were objective and subjective changes in voiding. Secondary outcomes were transurethral catheterization length and the need for clean intermittent self-catheterization (CISC). Results: Of 132 men, 89 (67%) underwent Robot-assisted Laparoscopic Colpectomy (RaLC) and 43 (33%) Vaginal Colpectomy (VC). Maximum flow rate on uroflowmetry decreased following RaLC (mean of 29.1 vs. 38.3 mL/s, p = 0.002) and VC (mean of 29.2 vs. 40.3 mL/s, p < 0.001) after a median of four months postoperatively. An increase in total International Prostate Symptom Score was seen more frequently following VC compared to RaLC. Subjective changes were indicated by 39%, more often by men who underwent VC, of which the majority improved during the first months postoperatively. Trial without catheter (TWOC) on the first postoperative day was more successful after RaLC (79/89, 89%) than VC (24/43, 56%). Secondary TWOC was successful in 22/132 (17%) patients after a median of eight days postoperatively. In 5/132 (4%) men (three VC and two RaLC), temporary CISC was necessary for a period ranging from 5 to 21 days. The last 2/132 (2%) men after RaLC were still performing CISC at end of follow-up. Eventually, 5% (two VC and four RaLC) had to refrain from genital gender-affirming surgery with urethral lengthening due to voiding dysfunction. Discussion: After colpectomy, most objective and subjective worsening in LUTF is of a temporary nature, however, 5% had to refrain from genital gender-affirming surgery with urethral lengthening due to persistent voiding dysfunction, despite the desire to void while standing.
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Affiliation(s)
- Freek P. W. de Rooij
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Brechje L. Ronkes
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Freek A. Groenman
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Garry L. S. Pigot
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Benoit L, Dabi Y, Bazot M, Thomassin-Naggara I, Ferrier C, Puchar A, Owen C, Touboul C, Darai E, Bendifallah S. Parametrial Endometriosis: a predictive and prognostic factor for voiding dysfunction and complications. Eur J Obstet Gynecol Reprod Biol 2022; 276:236-243. [DOI: 10.1016/j.ejogrb.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/05/2022] [Accepted: 07/31/2022] [Indexed: 11/26/2022]
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Xu P, Wang J, Zhang Y, Zhu L, Zhang X. Factors Affecting the Postoperative Bowel Function and Recurrence of Surgery for Intestinal Deep Endometriosis. Front Surg 2022; 9:914661. [PMID: 35774384 PMCID: PMC9239406 DOI: 10.3389/fsurg.2022.914661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to evaluate the factors associated with complications and long-term results in the surgical treatment of intestinal deep endometriosis and to figure out the optimized treatment measures for bowel endometriosis.MethodsA retrospective study was performed in a single center in China. Medical charts were reviewed from 61 women undergoing surgical treatment for bowel endometriosis between January 2013 and August 2019 in the Department of General Gynecology, Women’s Hospital School of Medicine Zhejiang University. Multivariate regression analysis was utilized to investigate the impact of the stages of endometriosis and surgical steps (independent risk factors) on complications (and postoperative bowel dysfunction). The clinical characters, surgical procedures, postoperative treatment, complications, and recurrence rate were summarized and analyzed by using Lasso regression.ResultsSurgery type was the most important independent risk factor related to postoperative abnormal defecation in intestinal deep endometriosis patients (P < 0.05, OR = 34.133). Infection is the most important independent risk factor related to both postoperative complications (OR = 96.931) and recurrences after conservative surgery (OR = 4.667). Surgery type and age were significantly related to recurrences after conservative surgery.ConclusionsWe recommended conservative operation especially full-thickness disc excision to improve the quality of life of intestinal deep endometriosis patients. In addition, prevention of infection is very important to reduce the postoperative complications rate and the recurrence rate.
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Borghese G, Coppola F, Raimondo D, Raffone A, Travaglino A, Bortolani B, Lo Monaco S, Cercenelli L, Maletta M, Cattabriga A, Casadio P, Mollo A, Golfieri R, Paradisi R, Marcelli E, Seracchioli R. 3D Patient-Specific Virtual Models for Presurgical Planning in Patients with Recto-Sigmoid Endometriosis Nodules: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010086. [PMID: 35056394 PMCID: PMC8777715 DOI: 10.3390/medicina58010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Background and Objective: In recent years, 3D printing has been used to support surgical planning or to guide intraoperative procedures in various surgical specialties. An improvement in surgical planning for recto-sigmoid endometriosis (RSE) excision might reduce the high complication rate related to this challenging surgery. The aim of this study was to build novel presurgical 3D models of RSE nodules from magnetic resonance imaging (MRI) and compare them with intraoperative findings. Materials and Methods: A single-center, observational, prospective, cohort, pilot study was performed by enrolling consecutive symptomatic women scheduled for minimally invasive surgery for RSE between November 2019 and June 2020 at our institution. Preoperative MRI were used for building 3D models of RSE nodules and surrounding pelvic organs. 3D models were examined during multi-disciplinary preoperative planning, focusing especially on three domains: degree of bowel stenosis, nodule’s circumferential extension, and bowel angulation induced by the RSE nodule. After surgery, the surgeon was asked to subjectively evaluate the correlation of the 3D model with the intra-operative findings and to express his evaluation as “no correlation”, “low correlation”, or “high correlation” referring to the three described domains. Results: seven women were enrolled and 3D anatomical virtual models of RSE nodules and surrounding pelvic organs were generated. In all cases, surgeons reported a subjective “high correlation” with the surgical findings. Conclusion: Presurgical 3D models could be a feasible and useful tool to support surgical planning in women with recto-sigmoidal endometriotic involvement, appearing closely related to intraoperative findings.
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Affiliation(s)
- Giulia Borghese
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Francesca Coppola
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
- Correspondence: (D.R.); (A.R.)
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
- Correspondence: (D.R.); (A.R.)
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, 80138 Naples, Italy;
| | - Barbara Bortolani
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (B.B.); (L.C.); (E.M.)
| | - Silvia Lo Monaco
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Laura Cercenelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (B.B.); (L.C.); (E.M.)
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Arrigo Cattabriga
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Rita Golfieri
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Roberto Paradisi
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Emanuela Marcelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (B.B.); (L.C.); (E.M.)
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
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Lamrabet S, Bekhouche A, Wanpouille C, Rousset P, Thomassin-Naggara I. Classification dPEI : une nouvelle classification IRM de l’endométriose pelvienne profonde. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Borghese G, Raimondo D, Esposti ED, Aru AC, Raffone A, Orsini B, Ambrosio M, Iodice R, Lenzi J, Del Forno S, Casadio P, Seracchioli R. Preoperative ureteral stenting in women with deep posterior endometriosis and ureteral involvement: Is it useful? Int J Gynaecol Obstet 2021; 158:179-186. [PMID: 34606100 DOI: 10.1002/ijgo.13959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/16/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Systematic placement of a ureteral stent before surgery for posterior deep infiltrating endometriosis (DIE) was previously recommended, but it could increase perioperative complications. We evaluate the role of preoperative ureteral stent in women requiring surgery for ureteral involvement (UI) with large posterior DIE nodules and/or grade I-II hydronephrosis. METHODS Women undergoing minimally invasive surgery for DIE with UI having posterior nodules >3 cm and/or grade I-II hydronephrosis from 2014 to 2019 were retrospectively included. We progressively changed our strategy from a systematic pre-operative stent insertion (S-PS, up to 2016) to a non-systematic one (NS-PS, from 2016). RESULTS Eighty-eight women in the S-PS group and 96 in the NS-PS were included. Low urinary tract infections (UTI) were higher in the S-PS group (13.6% vs 2.1%, P = 0.003). Hospital stay was longer in women with S-PS (9.8 ± 5.3 days vs 6.7 ± 2.5 days, P < 0.001). Logistic regression analysis confirmed a significant association between NS-PS and low UTI (adjusted OR 0.20, 95% CI 0.05-0.81, P = 0.024). CONCLUSION Systematic placement of a ureteral stent before surgery in women requiring surgery does not reduce overall perioperative complication rate, but it is associated with a longer duration of hospitalization and a higher low UTI rate.
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Affiliation(s)
- Giulia Borghese
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Anna Chiara Aru
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Benedetta Orsini
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Raffaella Iodice
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), UOC Ginecologia e Fisiopatologia della Riproduzione Umana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
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Hochstätter R, Bertholin y Galvez MC, Hartleb R, Laback C, Aigmüller T, Tamussino K, Gold D. Voiding dysfunction after colpectomy and urethral lengthening in transgender men. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:108-112. [PMID: 36713147 PMCID: PMC9879163 DOI: 10.1080/26895269.2021.1924916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Colpectomy is a frequent part of gender-affirming surgery in transgender men. Urologic complications with these procedures can complicate and delay further management. Aim: We reviewed the rate of postoperative voiding dysfunction after colpectomy with urethral lengthening in transgender men. METHODS We reviewed postoperative voiding in 47 transgender men (age, 19-50 years) who underwent colpectomy with urethral lengthening. Thirty-eight patients (81%) had undergone hysterectomy (36 total, 2 subtotal/supracervical) previously and 11 (23%) underwent concomitant hysterectomy or removal of the residual cervix (4 abdominal, 6 laparoscopic, 1 transvaginal). Colpectomy was done transvaginally by opening and developing laterally the vesicovaginal and rectovaginal spaces and then transecting the lateral vaginal attachments with bipolar vessel sealing. Urethral lengthening with an anterior vaginal flap was performed in the same procedure as colpectomy. A transurethral catheter was left in situ for 14 days postoperatively. Voiding dysfunction was defined as failure of spontaneous micturition after removal of the catheter at 14 days. RESULTS 40/47 (85%) patients were able to void after catheter removal, 7 (15%) were not. Voiding dysfunction occurred in 3/11 (27%) patients undergoing concomitant hysterectomy or removal of a residual cervix and in 4/36 patients (11%) status post total hysterectomy. Voiding dysfunction persisted for a median of 3 months (2 days - 46 months). CONCLUSIONS In this series voiding dysfunction developed in 15% of transgender men undergoing colpectomy with urethral lengthening and appeared to be more common in patients undergoing concomitant hysterectomy or removal of a residual cervix than in those status post hysterectomy. Patients should be counseled accordingly.
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Affiliation(s)
- Rüdiger Hochstätter
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Riccarda Hartleb
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Christian Laback
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria
| | - Thomas Aigmüller
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Daniela Gold
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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12
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Thomassin-Naggara I, Lamrabet S, Crestani A, Bekhouche A, Wahab CA, Kermarrec E, Touboul C, Daraï E. Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management. Hum Reprod 2021; 35:1589-1600. [PMID: 32619220 DOI: 10.1093/humrep/deaa103] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Is an MRI classification of deep pelvic endometriosis (DE) able to correctly predict the risk of DE surgery. SUMMARY ANSWER A new radiological classification, that we have called the deep pelvic endometriosis index (dPEI) classification, is accurate and reproducible to assess the extension of the disease in central and lateral compartments and well correlated with operating time, hospital stay duration and the risk of voiding dysfunction. WHAT IS KNOWN ALREADY Few imaging classifications are currently available to predict the extent of DE to help preoperative assessment of surgical outcomes and provide the patient with objective information about the risk of surgical complications. STUDY DESIGN, SIZE, DURATION Retrospective monocentric observational study was conducted between 01 January 2017 and 31 December 2018 and included 150 women (mean age = 34.5 years, 20-52 years) with DE on MRI and who subsequently underwent surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Two radiologists independently graded the disease according to MRI-based Enzian classification (A (rectovaginal septum and vagina locations), B (uterosacral locations) and C (rectosigmoid locations)) and a new radiological classification, that we have called the dPEI, that grades the severity of DE as: mild, moderate or severe DE. MRI findings and classification were correlated with surgical and pathological results. MAIN RESULTS AND THE ROLE OF CHANCE MRI-based and surgical Enzian classifications were concordant for A lesions in 78.7% (118/150), for B lesions in 34.7% (52/150) and for C lesions in 82.7% (124/150). Operating time and hospital stays were longer in Group A2 (rectovaginal septum and vagina, 1-3 cm) compared to A0, B2 (uterosacral, 1-3 cm) compared to B0, C3 (rectosigmoid >3 cm) compared to C2 (rectosigmoid 1-3 cm) or C0 (P < 0.001), in severe compared to moderate DE patients, and in moderate compared to mild extensive patients (P < 0.01). Patients with vaginal or rectosigmoid involvement were respectively six and three times more likely to experience high-grade complications according to Clavien-Dindo classification than patients without vaginal or rectosigmoid disease (P < 0.001). Postoperative voiding dysfunction was correlated with A lesions (odds ratio (OR) = 6.82, 95% CI 2.34-20.5), moderate or severe DE (OR = 4.15, 95% CI 1.26-17.9), the presence of at least unilateral lateral pelvic involvement (OR = 3.6, 95% CI 1.14-11.2, P = 0.03) and C lesions (OR = 2.6, 95% CI 1.03-6.8, P < 0.01). LIMITATIONS, REASONS FOR CAUTION The study was conducted in an expert center and needs to be validated in a multicenter study. There is a limited number of patients with lateral pelvic endometriosis beyond the parietal fascia, probably due to the low prevalence of this disease presentation. WIDER IMPLICATIONS OF THE FINDINGS MRI imaging can be used to accurately predict postoperative complications for women with DE. This may help the clinician to preoperatively inform a patient about the risks of surgery. Larger clinical studies are required to validate these results. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. I.T.N.: Remunerated lecture GE, Hologic, Guerbet, Canon; Advisory board: Siemens - These relationships are on the topic of breast imaging, not related to the topic of this paper. Other coauthors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Samia Lamrabet
- Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Adrien Crestani
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, GRC-6 (Clinical Research Group on Endometriosis) Sorbonne University, UMRS-938, 75020 Paris, France
| | - Asma Bekhouche
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Cendos Abdel Wahab
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Edith Kermarrec
- Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Cyril Touboul
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, GRC-6 (Clinical Research Group on Endometriosis) Sorbonne University, UMRS-938, 75020 Paris, France
| | - Emile Daraï
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, GRC-6 (Clinical Research Group on Endometriosis) Sorbonne University, UMRS-938, 75020 Paris, France
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13
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Bazot M, Beldjord S, Jarboui L, Ferrier C, Bendifallah S, Daraï E. Value of 3D MRI and Vaginal Opacification for the Diagnosis of Vaginal Endometriosis. Front Surg 2020; 7:614989. [PMID: 33392249 PMCID: PMC7775563 DOI: 10.3389/fsurg.2020.614989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023] Open
Abstract
Objective: The aim of the study was to evaluate three-dimensional (3D) T2 MRI before and after vaginal opacification (VO) by gel (3DT2VO) and the additional value of 3DT1 with fat-suppression (3DT1FS) MRI in the diagnosis of vaginal endometriosis. Methods: In this study conducted from 2010 to 2013, 51 patients scheduled for surgical treatment of endometriosis underwent MRI 1 day before surgery. Three readers (novice, intermediate, expert) were asked to retrospectively diagnose vaginal endometriosis independently and blindly using four different readings (i.e., 3DT2, 3DT2VO, 3DT2 with 3DT1FS, 3DT2VO with 3DT1FS). Vaginal endometriosis diagnosis was positive on observation of a thickening of vaginal walls on 3DT2 with or without high-signal-intensity spots on 3DT2 and/or 3DT1FS. The reference standard was surgery and histology. Descriptive analysis, Chi-square test, and ROC curves were used for statistical analysis. Results: For all readers, the combination of 3DT2 and 3DT1FS significantly improved the diagnosis of vaginal endometriosis compared with 3DT2 (p = 0.002, p = 0.02, and p = 0.003). 3DT2VO significantly improved diagnosis for the intermediate reader (p = 0.01). High-signal-intensity spots on 3DT1FS had a sensitivity of 50–63.6%, specificity of 86.2–96.6%, and high positive likelihood ratios (14.5-Inf). Conclusion: 3DT2 in association with 3DT1FS appears to be the best 3D MRI protocol for the diagnosis of vaginal endometriosis, whatever the level of experience of readers. The additional value of 3DT2VO is variable among the readers.
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Affiliation(s)
- Marc Bazot
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.,Groupe de Recherche Clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance Publique Des Hôpitaux de Paris, Tenon University Hospital, Sorbonne Université, Paris, France
| | - Selma Beldjord
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | | | - Clement Ferrier
- Groupe de Recherche Clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance Publique Des Hôpitaux de Paris, Tenon University Hospital, Sorbonne Université, Paris, France.,Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Groupe de Recherche Clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance Publique Des Hôpitaux de Paris, Tenon University Hospital, Sorbonne Université, Paris, France.,Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.,UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Emile Daraï
- Groupe de Recherche Clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance Publique Des Hôpitaux de Paris, Tenon University Hospital, Sorbonne Université, Paris, France.,Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.,UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine, Sorbonne Université, Paris, France
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14
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Agnello M, Vottero M, Bertapelle P. Sacral neuromodulation to treat voiding dysfunction in patients with previous pelvic surgery for deep infiltrating endometriosis: our centre's experience. Int Urogynecol J 2020; 32:1499-1504. [PMID: 32803341 PMCID: PMC8203508 DOI: 10.1007/s00192-020-04478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/27/2020] [Indexed: 12/04/2022]
Abstract
Introduction and hypothesis Voiding symptoms/dysfunctions (VS/Ds) after surgery for deep-infiltrating endometriosis (DIE) are frequent (20% of patients) and, together with bowel dysfunctions, may represent a de novo disorder due to surgical damage of the pelvic plexus or a worsening of pre-existent functional damage. Sacral neuromodulation (SNM) might improve voiding symptoms by treating dysfunctional voiding. The aim of this study is to report our experience with SNM in patients treated with surgery for DIE. Methods We retrospectively enrolled 13 patients with VS/Ds after surgery for DIE. All patients were investigated with urodynamic studies (UDS) and agreed to undergo SNM. Pre-existing VS/Ds, bowel disorders and pelvic pain, DIE surgical procedures, UDS and SNM test results were recorded. Results After surgery for DIE, functional bladder outflow obstruction and detrusor acontractility were observed in nine and four patients, respectively. Chronic pelvic pain was present in seven cases. Twelve patients developed constipation, whilst one patient had de novo faecal incontinence. After the SNM testing period, nine patients (69.2%) experienced a significant improvement of symptoms that led to definitive implant. Four patients (30.8%) had no symptom relief and the system was removed. Conclusions Functional bladder outflow obstruction and urinary retention are the most common VS/Ds after surgery for DIE. SNM may be an effective option for these patients, probably due to its action in improving the dysfunctional voiding, which was likely to be already present as part of the “endometriotic syndrome” and got worse after pelvic surgery. Results for pelvic pain control and gastrointestinal disorders should not be underestimated.
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Affiliation(s)
- Marco Agnello
- Università degli Studi di Torino, Torino, Italy. .,SC Urologia U, A.O.U. Città della Salute e della Scienza, Molinette Hospital (Corso Bramante 88, Torino - CAP 10126), Torino, Italy.
| | - Mario Vottero
- SC Neuro-Urologia, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Paola Bertapelle
- SC Neuro-Urologia, A.O.U. Città della Salute e della Scienza, Torino, Italy
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15
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Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb). Arch Gynecol Obstet 2020; 302:983-993. [PMID: 32676859 DOI: 10.1007/s00404-020-05694-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. METHODS All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. RESULTS Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. CONCLUSIONS Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
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16
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Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC WOMENS HEALTH 2020; 20:111. [PMID: 32434535 PMCID: PMC7240912 DOI: 10.1186/s12905-020-00974-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Background To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
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Affiliation(s)
- Hungling Kwok
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Tian Li
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People's Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hui Fei
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Cheng
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuqin Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
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17
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Raimondo D, Borghese G, Mabrouk M, Arena A, Ambrosio M, Del Forno S, Degli Esposti E, Casadio P, Mattioli G, Mastronardi M, Seracchioli R. Use of Indocyanine Green for Intraoperative Perfusion Assessment in Women with Ureteral Endometriosis: A Preliminary Study. J Minim Invasive Gynecol 2020; 28:42-49. [PMID: 32283326 DOI: 10.1016/j.jmig.2020.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To evaluate the feasibility, safety, and potential usefulness of near-infrared imaging (NIR) with indocyanine green (ICG) to assess ureteral perfusion after conservative surgery (ureterolysis or nodule removal) for ureteral endometriosis. Any changes to the surgical plan regarding intraoperative ureteral stent placement after NIR-ICG evaluation and early postoperative outcomes were recorded. DESIGN Prospective case series study. SETTING Tertiary level referral center for endometriosis and minimally invasive gynecology. PATIENTS Consecutive symptomatic women scheduled for laparoscopic conservative ureteral surgery for ureteral endometriosis. INTERVENTIONS After ureterolysis or nodule removal, residual perfusion of the ureters with regular caliber and peristalsis was evaluated through NIR-ICG imaging. Ureteral perfusion grade was defined as absent, irregular, or regular. Time required for NIR-ICG assessment, interoperator agreement regarding ureteral perfusion grade, any changes to the surgical plan after NIR-ICG evaluation, perioperative complications, and clinical-radiologic outcomes at early follow-up were recorded. MEASUREMENTS AND MAIN RESULTS A total of 31 ureters were examined with NIR-ICG imaging after conservative ureteral procedures. ICG assessment required 5.4 + 2.3 minutes. No complications related to fluorescence imaging were observed. Local ischemia supporting ureteral stent placement was suspected in 5 ureters (16.1%) at white light. Of these, 2 (40.0%) presented regular fluorescence; thus, ureteral stent placement was avoided. In the remaining 3 (60.0%), NIR-ICG confirmed irregular or absent fluorescence, requiring ureteral stent placement. Interoperator agreement regarding NIR-ICG evaluation was high. At a 3-month follow-up, all procedures were clinically and radiologically successful. CONCLUSION NIR-ICG imaging after conservative surgery for ureteral endometriosis seems to be a feasible, safe, and useful tool to assess ureteral perfusion and guide surgical decision, together with other visual cues at white light. However, this approach needs to be validated by further larger and controlled studies.
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Affiliation(s)
- Diego Raimondo
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Giulia Borghese
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli).
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cambridge Clinical School, The Rosie Hospital, Cambridge, United Kingdom (Dr. Mabrouk)
| | - Alessandro Arena
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Marco Ambrosio
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Simona Del Forno
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Eugenia Degli Esposti
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Paolo Casadio
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Giulia Mattioli
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Manuela Mastronardi
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
| | - Renato Seracchioli
- Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli)
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Raimondo D, Turco LC, Cosentino F, Mabrouk M, Mastronardi M, Borghese G, Giaquinto I, Vargiu V, Fagotti A, Meriggiola MC, Chiantera V, Scambia G, Seracchioli R. Feasibility and safety of two different surgical routes for the eradication of recto‐vaginal endometriosis with vaginal mucosa infiltration (Endo‐Vag‐r study). Acta Obstet Gynecol Scand 2020; 99:1050-1056. [DOI: 10.1111/aogs.13824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Diego Raimondo
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Luigi C. Turco
- Division of Gynecologic Oncology Fondazione di Ricerca e Cura Giovanni Paolo II Università Cattolica del Sacro Cuore Campobasso Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology Fondazione di Ricerca e Cura Giovanni Paolo II Università Cattolica del Sacro Cuore Campobasso Italy
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
- Department of Obstetrics and Gynecology Faculty of Medicine University of Cambridge Cambridge UK
- Department of Obstetrics and Gynecology Faculty of Medicine University of Alexandria Alexandria Egypt
| | - Manuela Mastronardi
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Ilaria Giaquinto
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Virginia Vargiu
- Department of Women's and Children's Health Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Anna Fagotti
- Gynecologic Oncology Università Cattolica del Sacro Cuore Rome Italy
| | - Maria C. Meriggiola
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology University of Palermo Palermo Italy
| | - Giovanni Scambia
- Gynecologic Oncology Università Cattolica del Sacro Cuore Rome Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
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Nicolaus K, Zschauer S, Bräuer D, Jimenez-Cruz J, Lehmann T, Rengsberger M, Diebolder H, Runnebaum IB. Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 2020; 301:699-706. [PMID: 31989287 DOI: 10.1007/s00404-019-05425-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to assess post-operative complications based on the Clavien-Dindo classification system following routine laparoscopic treatment of all stages of endometriosis. METHODS A retrospective cohort study was carried out to identify women who underwent laparoscopic complete resection of newly diagnosed endometriosis between 2013 and 2016. 401 patients were identified using hospital database search software, and electronic files were reviewed. The stages of endometriosis had been classified according to the revised score of the American Society of Reproductive Medicine (rASRM) and the Enzian classification in cases of deep infiltrating endometriosis. Post-operative complications were recorded based on the Clavien-Dindo classification. Multivariate regression analysis was used to investigate the impact of the stages of endometriosis and surgical steps on complications. RESULTS Grade III complications requiring surgical, endoscopic, or radiological intervention occurred in only 1.7% of patients and were significantly associated with rASRM stage IV (OR 1.8). Grade II complications (blood transfusion, total parenteral nutrition) occurred in 18.7% of patients. rASRM stage IV (OR 2.0), hysterectomy (OR 3.2), conversion to laparotomy (OR 11.1), and bowel resection (OR 27.6) were significantly associated with increased risk of grade II complications. rASRM stages I-III did not show an effect on post-operative complications or hospital stay. CONCLUSIONS Clavien-Dindo complication grading was readily applicable to laparoscopic removal of endometriosis of all stages. Higher Clavien-Dindo grades correctly reflected clinically relevant complications and were associated with deep infiltrating endometriosis, stage IV endometriosis, bowel surgery, or hysterectomy. Clavien-Dindo classification can be recommended for evaluation of laparoscopic endometriosis surgery outcome.
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Affiliation(s)
- Kristin Nicolaus
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Stefan Zschauer
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Dominik Bräuer
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Jorge Jimenez-Cruz
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
- Department of Obstetrics and Prenatal Medicine, University Women's Hospital Bonn, Bonn, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Rengsberger
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Herbert Diebolder
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany.
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20
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Parametrial Endometriosis: The Occult Condition that Makes the Hard Harder. J Minim Invasive Gynecol 2019; 26:871-876. [DOI: 10.1016/j.jmig.2018.08.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023]
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21
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Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol 2019; 239:21-29. [PMID: 31163353 DOI: 10.1016/j.ejogrb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/20/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
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Affiliation(s)
- Johannes Lermann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
| | - Nalan Topal
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany; Department of Obstetrics and Gynecology, Klinikverbund Südwest, Klinikum Sindelfingen-Böblingen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefanie Burghaus
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Felix Heindl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
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22
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Nikkels C, van Trotsenburg M, Huirne J, Bouman MB, de Leeuw R, van Mello N, Ronkes B, Groenman F. Vaginal Colpectomy in Transgender Men: A Retrospective Cohort Study on Surgical Procedure and Outcomes. J Sex Med 2019; 16:924-933. [DOI: 10.1016/j.jsxm.2019.03.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
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23
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Vesale E, Boudy AS, Zilberman S, Bendifallah S, Ileko A, Darai E. [Rectovaginal fistula prevention after enbloc colorectal resection and hysterectomy for deep endometriosis]. ACTA ACUST UNITED AC 2019; 47:378-380. [PMID: 30782474 DOI: 10.1016/j.gofs.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 10/27/2022]
Affiliation(s)
- E Vesale
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance publique-des Hôpitaux de Paris (AP-HP), Sorbonne University, 75000 Paris, France.
| | - A S Boudy
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance publique-des Hôpitaux de Paris (AP-HP), Sorbonne University, 75000 Paris, France
| | - S Zilberman
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance publique-des Hôpitaux de Paris (AP-HP), Sorbonne University, 75000 Paris, France
| | - S Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance publique-des Hôpitaux de Paris (AP-HP), Sorbonne University, 75000 Paris, France; Groupe de recherche clinique 6 (GRC6-UPMC), centre expert en endométriose (C3E), 75020 Paris, France; UMR_S938 Sorbonne University, 75000 Paris, France
| | - A Ileko
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance publique-des Hôpitaux de Paris (AP-HP), Sorbonne University, 75000 Paris, France
| | - E Darai
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance publique-des Hôpitaux de Paris (AP-HP), Sorbonne University, 75000 Paris, France; Groupe de recherche clinique 6 (GRC6-UPMC), centre expert en endométriose (C3E), 75020 Paris, France; UMR_S938 Sorbonne University, 75000 Paris, France
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24
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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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Raimondo D, Mabrouk M, Zannoni L, Arena A, Zanello M, Benfenati A, Moro E, Paradisi R, Seracchioli R. Severe ureteral endometriosis: frequency and risk factors. J OBSTET GYNAECOL 2017; 38:257-260. [PMID: 28969477 DOI: 10.1080/01443615.2017.1349083] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ureteral endometriosis (UE) can be classified as severe when there is obstruction to urinary flow (ureteral compression (UC)). In this retrospective study on 205 patients, we evaluated intraoperatively the frequency of severe ureteral endometriosis (UE) in women with UE and, secondarily, risk factors associated with UC. We documented intraoperatively ureteral UC in 124 (60.5%) patients with UE. A significantly lower body mass index (BMI) was observed in women with UC than in women without UC (p = .02). A significant association was found between UC and parametrial endometriosis (p = .001). In multivariable analysis, these variables remained significantly associated with UC. Ureteral compression is common in patients with UE, especially in women with parametrial infiltration and a low BMI.
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Affiliation(s)
- Diego Raimondo
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Mohamed Mabrouk
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy.,b Department of Obstetrics and Gynecology , Alexandria University , Alexandria , Egypt
| | - Letizia Zannoni
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Alessandro Arena
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Margherita Zanello
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Arianna Benfenati
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Elisa Moro
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Roberto Paradisi
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
| | - Renato Seracchioli
- a Department of Gynecology and Reproductive Biology , S. Orsola Hospital, University of Bologna , Bologna , Italy
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Ercoli A, Bassi E, Ferrari S, Surico D, Fagotti A, Fanfani F, De Cicco F, Surico N, Scambia G. Robotic-Assisted Conservative Excision of Retrocervical-Rectal Deep Infiltrating Endometriosis: A Case Series. J Minim Invasive Gynecol 2017; 24:863-868. [DOI: 10.1016/j.jmig.2017.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/27/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
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27
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Renner SP, Kessler H, Topal N, Proske K, Adler W, Burghaus S, Haupt W, Beckmann MW, Lermann J. Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 2017; 295:1277-1285. [DOI: 10.1007/s00404-017-4360-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
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Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study. Surg Endosc 2016; 31:3363-3369. [PMID: 27844235 PMCID: PMC5501901 DOI: 10.1007/s00464-016-5333-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/31/2016] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gender-affirming surgeries in female-to-male (FtM) transgender patients include mostly hysterectomy, bilateral salpingo-oophorectomy and mastectomy. Sometimes further surgery is performed, such as phalloplasty. Colpectomy may be performed to overcome gender dysphoria and disturbing vaginal discharge; furthermore, it may be important in reducing the risk of fistulas due to the phalloplasty procedure with urethral elongation. Colpectomy prior to the reconstruction of the neourethra seems to reduce fistula rates on the very first anastomosis. Therefore, at our center, colpectomy has become a standard procedure prior to phalloplasty and metoidioplasty with urethral elongation. Colpectomy is known as a procedure with potentially serious complications, e.g., extensive bloodloss, vesicovaginal fistula or rectovaginal fistula. Colpectomy performed via the vaginal route can be a challenging procedure due to lack of exposure of the surgical field, as many patients are virginal. Therefore, we investigated whether robot-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH-BSO) followed by robot-assisted laparoscopic colpectomy (RaLC) is an alternative for the vaginal approach. METHODS Robot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study. RESULTS Median length of the procedure was 230 min (197-278), which reduced in the second half of the patients, median blood loss was 75 mL (30-200), and median discharge was 3 days (2-3) postoperatively. One patient with a major complication (postoperative bleeding with readmission and transfusion) was reported. CONCLUSION To our knowledge, this is the first report of RaLC. Our results show that RaLC combined with robot TLH-BSO is feasible as a single-step surgical procedure in FtM transgender surgery. Future studies are needed to compare this technique to the two-step surgical approach and on its outcome and complication rates of subsequent phalloplasty.
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Moszkowicz D, Rougier G, Julié C, Nyangoh Timoh K, Beauchet A, Vychnevskaia K, Malafosse R, Nordlinger B, Peschaud F. Total mesorectal excision for cancer: histological and immunohistochemical evidence of nerve removal and risk-factor analysis. Colorectal Dis 2016; 18:O367-O375. [PMID: 27591734 DOI: 10.1111/codi.13501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/26/2016] [Indexed: 12/14/2022]
Abstract
AIM Whether or not nerve-sparing rectal-cancer surgery can effectively prevent removal of the pelvic autonomic nerves has not been substantiated microscopically. We aimed to analyse the quality of nerve preservation in female patients by quantifying residual nerve fibres in total mesorectal excision specimens, to analyse pro-erectile function of the nerve fibres removed and to determine risk factors for pelvic denervation. METHOD Serial transverse sections from female patients, 64 ± 18 years of age, were studied after the mesorectal fascia was inked and studied histologically [using anti-S100 and anti-neuronal nitric oxide synthase (nNOS) antibodies]. Nerve fibres located within 1 mm of the inked surface were counted and analysed according to type of surgery, tumour location, pT stage, circumferential resection margin and the necessity for a posterior colpectomy. RESULTS Twelve specimens were analysed. Per specimen, the mean number of nerve-fibre sections outside the mesorectum was 5.3 ± 3.6 (range: 1-12). The mean number of fibres per specimen was 6.4 ± 4.1 in patients having a low-rectal tumour and 4.4 ± 2.9 in those with mid or higher rectal tumours (P = 0.42). The mean number of fibres was higher (9.2) for T4 tumours than for T2/T3 tumours (5.0 ± 3.5), but this difference was not statistically sigmificant (P = 0.25). Patients having abdominoperineal excision, a posterior colpectomy or a circumferential resection margin of less than 1 mm had significantly more nerve fibres in the specimen (10.6 ± 1.9 vs 4.4 ± 2.8; P = .041). Fibres localized at the anterolateral rectum corresponded to branches of the neurovascular bundle, expressing rich pro-erectile activity (positive anti-nNOS immunostaining). CONCLUSION The neurovascular bundle is a key risk zone for pelvic denervation during total mesorectal excision. Abdominoperineal excision, posterior colpectomy and an invaded circumferential resection margin are associated with perineal denervation.
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Affiliation(s)
- D Moszkowicz
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France.,UVSQ, Paris Saclay University, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux, France
| | - G Rougier
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France
| | - C Julié
- UVSQ, Paris Saclay University, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux, France.,AP-HP, Hôpital Ambroise Paré, Service d'anatomo-pathologie, Boulogne-Billancourt, France
| | - K Nyangoh Timoh
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France.,UVSQ, Paris Saclay University, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux, France
| | - A Beauchet
- AP-HP, Hôpital Ambroise Paré, Service de biostatistiques, Boulogne-Billancourt, France
| | - K Vychnevskaia
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France.,UVSQ, Paris Saclay University, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux, France
| | - R Malafosse
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France
| | - B Nordlinger
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France
| | - F Peschaud
- AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métabolique, Boulogne-Billancourt, France. .,UVSQ, Paris Saclay University, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux, France.
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Identification des sites anatomiques à risque de lésion nerveuse lors de chirurgie pour endométriose pelvienne profonde. ACTA ACUST UNITED AC 2016; 44:302-8. [DOI: 10.1016/j.gyobfe.2016.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/31/2022]
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Nyangoh Timoh K, Canlorbe G, Verollet D, Peyrat L, Ballester M, Amarenco G, Darai E. Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 190:31-5. [PMID: 25966436 DOI: 10.1016/j.ejogrb.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Around 5% of women experience persistent voiding dysfunction after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement. The gold standard to manage persistent voiding dysfunction is intermittent self-catherization, but this treatment may reduce quality of life of the patients due to care constraints. The objective of our study was to assess the contribution of sacral neuromodulation (SNM) in the management of persistent voiding dysfunction secondary to surgery for DIE with colorectal resection. STUDY DESIGN Five patients referred for persistent voiding dysfunction after surgery for DIE with colorectal resection were included and fitted with a temporary SNM system to test for feasibility. This consisted of placing an electrode unilaterally next to the S3 sacral nerve root and connecting it to an external pacemaker. The patients wore the electrode and the external neurostimulator for 21 days and kept a voiding diary. The SNM test was considered positive when a 50% decrease in self-catheterization was achieved after removal of the electrode. The system was implanted permanently in patients with a positive SNM test. Urodynamic tests were performed before and after the SNM test. RESULTS Two of the five patients had a positive SNM test and were implanted permanently. At 40 months the first patient had completely stopped self-catheterization and the second patient was performing self-catheterization twice a day with a post voiding residue volume of less than 100ml at 52 months. CONCLUSION SNM could be a curative technique in some patients with persistent voiding dysfunction after surgery for DIE. Further studies are required to better select patients who might benefit from SNM testing and subsequent device implantation.
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Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Geoffroy Canlorbe
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Delphine Verollet
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Laurence Peyrat
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France; Department of Urology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Gérard Amarenco
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Emile Darai
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL, Schweppe KW. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis: Long Version - AWMF Registry No. 015-045. Geburtshilfe Frauenheilkd 2014; 74:1104-1118. [PMID: 26157194 PMCID: PMC4470398 DOI: 10.1055/s-0034-1383187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic.
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Affiliation(s)
- U. Ulrich
- Department of Obstetrics and Gynecology, Martin Luther Hospital,
Berlin
| | - O. Buchweitz
- Gynecological Outpatient Surgery Altonaer Straße, Hamburg
| | - R. Greb
- Center for Reproductive Medicine, Dortmund
| | - J. Keckstein
- Department of Obstetrics and Gynecology, Provincial Hospital,
Villach
| | - I. von Leffern
- Department of Obstetrics and Gynecology, Albertinen Hospital,
Hamburg
| | - P. Oppelt
- Department of Obstetrics and Gynecology, Provincial Womenʼs and
Childrenʼs Hospital, Linz
| | - S. P. Renner
- Department of Obstetrics and Gynecology, University of Erlangen School
of Medicine
| | - M. Sillem
- Gynecological Practice and Clinic Rosengarten, Mannheim
| | - W. Stummvoll
- Departement of Gynecology, Hospital of the Sisters of Mercy,
Linz
| | - R.-L. De Wilde
- Department of Obstetrics, Gynecology, and Gynecologic Oncology, Pius
Hospital Oldenburg, University of Oldenburg School of Medicine
| | - K.-W. Schweppe
- Endometriosis Center Ammerland, Ammerland Clinic,
Westerstede
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Richard F, Canlorbe G, Bazot M, Daraï E. Management of pregnancy in woman with suspected malignant deep infiltrating endometriosis fistulised to the uterine cervix. BMJ Case Rep 2014; 2014:bcr2014204978. [PMID: 24899016 PMCID: PMC4054261 DOI: 10.1136/bcr-2014-204978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/03/2022] Open
Abstract
Deep infiltrating endometriosis (DIE) is a well-known cause of pelvic pain and infertility. Malignant transformation of DIE is rare but can be suggested by MRI. We report a case of a spontaneous pregnancy in a woman with suspicion of malignant transformation of DIE with fistulisation to the posterior uterine isthmus through to the cervical canal. The pregnancy was closely monitored and an uneventful caesarian section was performed at 34 weeks of gestation. This case raises the issue of the relevance of imaging techniques and management of pregnancy.
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Affiliation(s)
- Frederic Richard
- Service de Gynécologie-obstétrique et Médecine de la Reproduction,Hôpital Tenon, Paris, France
| | - Geoffroy Canlorbe
- Service de Gynécologie-obstétrique et Médecine de la Reproduction,Hôpital Tenon, Paris, France
| | - Marc Bazot
- Service de Radiologie, Hôpital Tenon, Paris, France
| | - Emile Daraï
- Service de Gynécologie-obstétrique et Médecine de la Reproduction,Hôpital Tenon, Paris, France
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Rimbach S, Ulrich U, Schweppe KW. Surgical Therapy of Endometriosis: Challenges and Controversies. Geburtshilfe Frauenheilkd 2013; 73:918-923. [PMID: 24771943 DOI: 10.1055/s-0033-1350890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is one of the most common disorders encountered in surgical gynaecology. The laparoscopic technique, the planning of the surgical intervention, the extent of information provided to patients and the interdisciplinary coordination make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms. However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgical strategies. Thus, the excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to nerve structures during resection of the uterosacral ligaments, the parametrium, the rectovaginal septum or the vaginal cuff to treat deep infiltrating endometriosis can lead to serious functional impairments such as voiding disorders. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach.
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Affiliation(s)
- S Rimbach
- Gynäkologie und Geburtshilfe, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, Schweppe KW. Interdisciplinary S2k Guidelines for the Diagnosis and Treatment of Endometriosis: Short Version - AWMF Registry No. 015-045, August 2013. Geburtshilfe Frauenheilkd 2013; 73:890-898. [PMID: 24771938 PMCID: PMC3975317 DOI: 10.1055/s-0033-1350810] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
| | | | - R Greb
- Kinderwunschzentrum Dortmund, Dortmund
| | - J Keckstein
- Abteilung für Gynäkologie und Geburtshilfe, Landeskrankenhaus, Villach
| | - I von Leffern
- Klinik für Gynäkologie und Geburtshilfe, Albertinen-Krankenhaus, Hamburg
| | - P Oppelt
- Abteilung für Gynäkologie und Geburtshilfe, Landesfrauen- und Kinderklinik, Linz
| | - S P Renner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim
| | - W Stummvoll
- vormals Abteilung für Gynäkologie, Krankenhaus der Barmherzigen Schwestern, Linz
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