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Zegrea A, Ojala E, Suvitie P, Varpe P, Huhtinen H, Mäkelä‐Kaikkonen J, Rautio T, Härkki P, Salmenkylä S, Ukkonen M, Lavonius M, Pinta T. Sacral neuromodulation in endometriosis - A promising treatment option for chronic pelvic pain. Acta Obstet Gynecol Scand 2023; 102:1634-1642. [PMID: 37814355 PMCID: PMC10619602 DOI: 10.1111/aogs.14690] [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: 10/30/2022] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis. MATERIAL AND METHODS This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression - improvement (CGI-I), 15D-measure of health-related quality of life, and Biberoglu and Behrman (B&B) score. RESULTS A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one-year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2-9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain-related items. Worst experienced daily pain decreased among those who returned 12-month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4-12) to 4.5 (0-6), p = 0.002. CONCLUSIONS Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients.
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Affiliation(s)
| | - Emilia Ojala
- Turku University Hospital and University of TurkuTurkuFinland
| | - Pia Suvitie
- Turku University Hospital and University of TurkuTurkuFinland
| | - Pirita Varpe
- Turku University Hospital and University of TurkuTurkuFinland
| | - Heikki Huhtinen
- Turku University Hospital and University of TurkuTurkuFinland
| | | | - Tero Rautio
- Oulu University Hospital, Oulu Medical Research CenterOuluFinland
| | - Päivi Härkki
- Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | | | - Mika Ukkonen
- Tampere University Hospital and University of TampereTampereFinland
| | - Maija Lavonius
- Turku University Hospital and University of TurkuTurkuFinland
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Carugno J, Moawad N, Mikhail E. Time for a paradigm shift. Fertil Steril 2023; 120:815-816. [PMID: 37380096 DOI: 10.1016/j.fertnstert.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Division of Minimally Invasive Gynecology, University of Miami, Miller School of Medicine, Miami, Florida, United States
| | - Nash Moawad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida Health, Tampa, Florida, United States
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Hou HT, Lin TC, Wu MH, Tsai SJ. Feel so bac: is Fusobacterium the suspect causing endometriosis? Trends Mol Med 2023; 29:780-782. [PMID: 37599125 DOI: 10.1016/j.molmed.2023.08.003] [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: 07/21/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
Recent work by Muraoka and colleagues reports that the Gram-negative anaerobic bacterium Fusobacterium nucleatum is detected in the uterus of 64% of women with endometriosis. Fusobacterium infection causes macrophage infiltration, transforming growth factor-β production, and transgelin upregulation in human and mouse endometria as well as endometriotic lesion development in a mouse model of endometriosis.
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Affiliation(s)
- Huan-Tzu Hou
- Institute of Basic Medical Sciences, National Cheng Kung University Hospital, 1 University Road, Tainan 70101, Taiwan
| | - Ting-Chien Lin
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, 1 University Road, Tainan 70101, Taiwan
| | - Meng-Hsing Wu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, 1 University Road, Tainan 70101, Taiwan
| | - Shaw-Jenq Tsai
- Institute of Basic Medical Sciences, National Cheng Kung University Hospital, 1 University Road, Tainan 70101, Taiwan; Department of Physiology, College of Medicine, National Cheng Kung University, National Cheng Kung University Hospital, 1 University Road, Tainan 70101, Taiwan.
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Giudice LC, Oskotsky TT, Falako S, Opoku‐Anane J, Sirota M. Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations. FASEB J 2023; 37:e23130. [PMID: 37641572 PMCID: PMC10503213 DOI: 10.1096/fj.202300907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Endometriosis is a common estrogen-dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co-morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under-treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single-cell omics, and population-level data, endometriosis is well positioned to benefit from data-driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.
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Affiliation(s)
- Linda C. Giudice
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Center for Reproductive SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Tomiko T. Oskotsky
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Simileoluwa Falako
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jessica Opoku‐Anane
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of Gynecologic Specialty SurgeryColumbia UniversityNew YorkNew YorkUSA
| | - Marina Sirota
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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van Stein K, Schubert K, Ditzen B, Weise C. Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective. J Clin Med 2023; 12:4056. [PMID: 37373749 DOI: 10.3390/jcm12124056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.
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Affiliation(s)
- Katharina van Stein
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Kathrin Schubert
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
| | - Beate Ditzen
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
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Mardon AK, Leake HB, Hayles C, Henry ML, Neumann PB, Moseley GL, Chalmers KJ. The Efficacy of Self-Management Strategies for Females with Endometriosis: a Systematic Review. Reprod Sci 2023; 30:390-407. [PMID: 35488093 PMCID: PMC9988721 DOI: 10.1007/s43032-022-00952-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
Self-management is critical for the care of endometriosis. Females with endometriosis frequently use self-management strategies to manage associated symptoms; however, the efficacy of such strategies is unknown. The aim of this review was to systematically appraise the evidence concerning efficacy of self-management strategies for endometriosis symptoms. Electronic databases, including Medline, Embase, Emcare, Web of Science Core Collection, Scopus, and the Cochrane Central Register of Controlled Trials, were searched from inception to March 2021. We included peer-reviewed experimental studies published in English evaluating the efficacy of self-management strategies in human females laparoscopically diagnosed with endometriosis. Studies underwent screening, data extraction, and risk of bias appraisal (randomised studies: Risk of Bias 2 tool; non-randomised studies: Risk Of Bias In Non-randomized Studies - of Interventions tool). Of the fifteen studies included, 10 evaluated dietary supplements, three evaluated dietary modifications, one evaluated over-the-counter medication, and one evaluated exercise. Most studies had a high-critical risk of bias. Many self-management strategies were not more effective at reducing endometriosis symptoms compared to placebo or hormonal therapies. Where studies suggest efficacy for self-management strategies, no recommendations can be made due to the poor quality and heterogeneity of evidence. High-quality empirical evidence is required to investigate the efficacy of self-management strategies for females with endometriosis.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- Centre for IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Cathy Hayles
- University of South Australia, Adelaide, SA, Australia
| | - Michael L Henry
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | | | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.
- Western Sydney University, Campbelltown, NSW, Australia.
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Endometriosis and Infertility: A Long-Life Approach to Preserve Reproductive Integrity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106162. [PMID: 35627698 PMCID: PMC9141878 DOI: 10.3390/ijerph19106162] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
Laparoscopic surgery was originally considered the gold standard in the treatment of endometriosis-related infertility. Assisted reproductive technology (ART) was indicated as second-line treatment or in the case of male factor. The combined approach of surgery followed by ART proved to offer higher chances of pregnancy in infertile women with endometriosis. However, it was highlighted how pelvic surgery for endometriosis, especially in cases of ovarian endometriomas, could cause iatrogenic damage due to ovarian reserve loss, adhesion formation (scarring), and ischemic damage. Furthermore, in the last few years, the trend to delay the first childbirth, recent technological advances in ultrasound diagnosis, and technological progress in clinical and laboratory aspects of ART have certainly influenced the approach to infertility and endometriosis with, ART assuming a more relevant role. Management of endometriosis should take into account that the disease is chronic and involves the reproductive system. Consequently, treatment and counselling should aim to preserve the chances of pregnancy for the patient, even if it is not associated with infertility. This review will analyse the evolution of the management of infertility associated with endometriosis and propose an algorithm for treatment decision-making based on the most recent acquisitions.
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Coxon L, Wiech K, Vincent K. Is There a Neuropathic-Like Component to Endometriosis-Associated Pain? Results From a Large Cohort Questionnaire Study. FRONTIERS IN PAIN RESEARCH 2022; 2:743812. [PMID: 35295529 PMCID: PMC8915551 DOI: 10.3389/fpain.2021.743812] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pain is one of the primary symptoms of endometriosis, a chronic inflammatory condition characterised by the presence of endometrial tissue outside the uterus. Endometriosis-associated pain is commonly considered as nociceptive in nature, but its clinical presentation suggests that it might have neuropathic-like properties in a subgroup of patients. Methods: This is a cross sectional study using an online survey. The survey was distributed by patient support websites. The survey was composed of validated questionnaires assessing pain symptoms, psychological measures and questions about number of surgeries. Main Results: We had 1,417 responses which met the inclusion criteria. Using standard painDETECT cut-off scores, we found that pain was classified as neuropathic in 40% of patients and as mixed neuropathic/nociceptive in a further 35%. In line with observations in other neuropathic conditions, the neuropathic subgroup reported higher pain intensities, greater psychological distress and cognitive impairment. Neuropathic pain was also more likely in those with more surgeries to the abdomen and a longer history of pain. As revealed by a cluster analysis, those with a neuropathic pain component could further be divided into two subgroups based on their sensory profile. Conclusions: The data presented here indicate that endometriosis-associated pain includes a neuropathic-like component in a substantial proportion of women. Although further investigation is required, our finding challenges the current conceptualisation of endometriosis-associated pain as nociceptive and advocates for a new perspective on this type of pain, which is so debilitating to a large number of women.
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Affiliation(s)
- Lydia Coxon
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Katja Wiech
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Techatraisak K, Hestiantoro A, Soon R, Banal-Silao MJ, Kim MR, Seong SJ, Hidayat ST, Cai L, Shin S, Lee BS. Impact of Long-Term Dienogest Therapy on Quality of Life in Asian Women with Endometriosis: the Prospective Non-Interventional Study ENVISIOeN. Reprod Sci 2022; 29:1157-1169. [PMID: 35112299 PMCID: PMC8907083 DOI: 10.1007/s43032-021-00787-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/24/2021] [Indexed: 11/25/2022]
Abstract
Several clinical trials in women with endometriosis demonstrated that dienogest reduces endometrial lesions and improves health-related quality of life (HRQoL). To assess HRQoL in dienogest-treated patients in real-world setting, we conducted a prospective, non-interventional study in 6 Asian countries. Women aged ≥18 years with clinical or surgical diagnosis of endometriosis, presence of endometriosis-associated pelvic pain (EAPP) and initiating dienogest therapy were enrolled. The primary objective was to evaluate HRQoL using the Endometriosis Health Profile-30 (EHP-30) questionnaire. The secondary objectives included analysis of EAPP, satisfaction with dienogest, endometriosis symptoms and bleeding patterns. 887 patients started dienogest therapy. Scores for all EHP-30 scales improved with the largest mean changes at month 6 and 24 in scale pain (−28.9 ± 27.5 and − 34 ± 28.4) and control and powerlessness (−23.7 ± 28.2 and − 28.5 ± 26.2). Mean EAPP score change was −4.6 ± 3.0 for both month 6 and 24 assessments. EAPP decrease was similar in surgically and only clinically diagnosed patients. From baseline to month 24, rates of normal bleeding decreased (from 85.8% to 17.5%) while rates of amenorrhea increased (from 3.5% to 70.8%). Majority of patients and physicians were satisfied with dienogest. Over 80% of patients reported symptoms improvement. 39.9% of patients had drug-related treatment-emergent adverse events, including vaginal hemorrhage (10.4%), metrorrhagia (7.3%) and amenorrhea (6.4%). In conclusion, dienogest improves HRQoL and EAPP in the real-world setting in women with either clinical or surgical diagnosis of endometriosis. Dienogest might be a promising first-line treatment option for the long-term management of debilitating endometriosis-associated symptoms. NCT02425462, 24 April 2015.
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Affiliation(s)
- Kitirat Techatraisak
- Department of Obstetrics and Gynecology, Gynecologic Endocrinology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andon Hestiantoro
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ruey Soon
- Department of Obstetrics and Gynecology, Sabah Women's and Children's Hospital, Kota Kinabalu, Malaysia
| | - Maria Jesusa Banal-Silao
- Department of Obstetrics and Gynecology, St. Luke's Medical Center Global City, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Mee-Ran Kim
- Department of Obstetrics & Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | | | - Ling Cai
- Bayer Pharma AG, Wuppertal, Germany
| | - SoYoung Shin
- Former employee of Bayer AG, Seoul, Republic of Korea
| | - Byung Seok Lee
- Division of Gynecologic Endocrinology and Infertility, Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University, Seoul, Republic of Korea.
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
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Kim IH, Yoon H, Lee HJ, Noh HK, Joo JK, Kim KH. Observational Study for Adverse Effects and Discontinuation with Long-Term Post-Operative Hormonal Treatment for Endometriosis in Real-World Practice. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: To evaluate the side effects and causes of discontinuation of either combined oral contraceptives or dienogest (DNG) used to prevent recurrence in patients with surgically confirmed endometriosis.Methods: We retrospectively analyzed the medical records of 213 women with endometriosis who had been treated with combined oral contraceptives (ethinyl estradiol 0.02 mg/drospirenone 3 mg [EE/DRSP]) or DNG 2 mg for 12 months or more. The side effects reported by the patients, laboratory parameters, causes of discontinuation of medication, and recurrence rates were evaluated one, two, three, four, and five years after starting medication (Y1, Y2, Y3, Y4, and Y5).Results: EE/DRSP were administered to 59 patients, while DNG was administered to 154 patients. The mean durations of postoperative use of EE/DRSP and DNG were 44.5 ± 22.6 months and 23.6 ± 13.5 months, respectively. The prevalence of side effects was 27.1%, 19.0%, 10.0%, 10.5%, and 7.4% in the EE/DRSP group and 29.2%, 15.7%, 14.0%, 23.1%, and 0.0% in the DNG group at Y1, Y2, Y3, Y4, and Y5, respectively. The discontinuation rates were 1.7%, 1.7%, 4.0%, 0.0%, and 7.4% at Y1, Y2, Y3, Y4, and Y5, respectively, in the EE/DRSP group and 10.4%, 3.3%, 4.0%, 3.8%, and 0.0% at the same times in the DNG group. The recurrence rates were less than 4% in both the groups.Conclusions: The side effects of commonly prescribed postoperative hormone treatments were relatively mild, and the occurrence of side effects decreased with continuous administration. Further, the long-term use of postoperative hormone treatments is likely to prevent recurrence of endometriosis after surgery.
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Leonardi M, Alhayo S, Lu C, Gosal P, Reid S, Barto W, Condous G. The Postoperative State of the Pelvis After Bowel Surgery for Deep Endometriosis: Still an Ultrasound Mystery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2257-2258. [PMID: 33314232 DOI: 10.1002/jum.15596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Mathew Leonardi
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Sam Alhayo
- Colorectal Surgery Unit, Department of General Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Chuan Lu
- Department of Computer Sciences, University of Aberystwyth, Aberystwyth, UK
| | - Preet Gosal
- Colorectal Surgery Unit, Department of General Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Shannon Reid
- Department of Obstetrics and Gynecology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Walid Barto
- Colorectal Surgery Unit, Department of General Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - George Condous
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
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Bougie O, McClintock C, Pudwell J, Brogly SB, Velez MP. Long-term follow-up of endometriosis surgery in Ontario: a population-based cohort study. Am J Obstet Gynecol 2021; 225:270.e1-270.e19. [PMID: 33894154 DOI: 10.1016/j.ajog.2021.04.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/02/2021] [Accepted: 04/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endometriosis is a chronic gynecological disease affecting approximately 10% of reproductive aged females and leads to decreased quality of life and productivity. Despite effective medical options, many women do require surgery for endometriosis. There is limited literature examining long term outcomes of endometriosis surgery. OBJECTIVE This study aimed to characterize the long-term outcomes, including recurrence of symptoms, fertility outcomes, and need for reoperation, of patients who underwent surgical management for endometriosis. STUDY DESIGN This was a population-based cohort study in which the universal coverage health database for the province of Ontario, Canada, was used to identify women aged 18 to 50 years who underwent surgery for endometriosis from April 1, 2002, through March 31, 2018. Surgery was classified as diagnostic laparoscopy, conservative or uterine preserving (minor or major, with and without ovarian preservation), or hysterectomy (with and without ovarian preservation). The outcomes were evaluated from 30 days after the index surgery to the end of the study period or at censoring. Cox proportional hazard regression models were used to estimate the hazard ratios between exposures and outcomes following adjustment for confounders. RESULTS A total of 84,885 women 2,718 (3.2%) diagnostic laparoscopy, 21,594 (25.4%) minor conservative surgery, 28,484 (33.6%); major conservative with ovarian preservation, 2,102 (2.5%) major conservative without ovarian preservation, 21,609 (25.5%) hysterectomy with ovarian preservation, and 8,378 (9.9%) hysterectomy without ovarian preservation) were included in the cohort and followed for a median of 10 years (interquartile range, 6-13 years). In the first postoperative year, women who underwent diagnostic laparoscopy were significantly more likely to require repeat surgery (adjusted hazard ratio, 1.68; 95% confidence interval, 1.51-1.87), whereas those who underwent major conservative surgery were significantly less likely to require repeat surgery (with ovarian preservation: adjusted hazard ratio, 0.44; 95% confidence interval, 0.41-0.48; without ovarian preservation: adjusted hazard ratio, 0.05; 95% confidence interval, 0.03-0.09). Among women who did not receive repeat surgery in the first year, those who underwent a diagnostic laparoscopy (adjusted hazard ratio, 0.85; 95% confidence interval, 0.76-0.95) and major conservative surgery without ovarian preservation were less likely to undergo repeat surgery (adjusted hazard ratio, 0.12; 95% confidence interval, 0.09-0.18) than those who initially had minor surgery. Compared with those who initially underwent minor surgery, patients who underwent other treatment modalities were less likely to undergo a hysterectomy (diagnostic laparoscopy: adjusted hazard ratio, 0.85; 95% confidence interval, 0.75-0.96; major surgery with ovarian preservation: adjusted hazard ratio, 0.60; 95% confidence interval, 0.57-0.64; major surgery without ovarian preservation: adjusted hazard ratio, 0.05; 95% confidence interval, 0.03-0.08). Following minor and major conservative with ovarian preservation surgery, 8,331 (38.6%) and 9,498 (33.3%) of patients sought an infertility consult within 1 year, respectively. By 5 years after the index surgery, 5,290 (29.4%) of patients who had minor conservative surgery and 4,528 (20.7%) of those who had major conservative with ovarian preservation surgery had given birth at least once. CONCLUSION Our study suggests that only a few endometriosis patients who undergo hysterectomy surgery require repeat surgery; however, up to 1 in 4 who undergo minor surgery and 1 in 5 who undergo major conservative surgery with ovarian preservation require additional endometriosis surgery. Up to 1 in 3 patients who had uterine sparing endometriosis surgery subsequently sought an infertility assessment. These findings may inform preoperative counseling in terms of recurrence of symptoms, fertility outcomes, and need for reoperation of women seeking surgical management for endometriosis. Future studies should consider the outcomes of patient satisfaction and quality of life based on the current practices for management of endometriosis.
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Affiliation(s)
- Olga Bougie
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
| | - Chad McClintock
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Susan B Brogly
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Department of Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
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Masciullo L, Viscardi MF, Piacenti I, Scaramuzzino S, Cavalli A, Piccioni MG, Porpora MG. A deep insight into pelvic pain and endometriosis: a review of the literature from pathophysiology to clinical expressions. Minerva Obstet Gynecol 2021; 73:511-522. [PMID: 33904687 DOI: 10.23736/s2724-606x.21.04779-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis is a chronic inflammatory disease that affects approximately 10% of women of reproductive age. Its clinical manifestations are highly heterogeneous, but pelvic pain is the most frequent, causing functional disability. Cyclic or acyclic chronic pelvic pain (CPP), dysmenorrhea and dyspareunia are frequent symptoms which often compromise all aspects of the women's quality of life (QoL). The pathophysiology of endometriosis-related pain is extremely complex and not always clear. The aim of this literature review is to focus on recent updates on the clinical presentation, the pathophysiology and the most important mechanisms involved in the pathogenesis of pelvic pain in endometriosis. A literature search in the Cochrane library, PubMed, Scopus and web of Science databases has been performed, identifying articles from January 1995 to November 2020. Several processes seem to be involved in the pathogenesis of pain, but many aspects are still unclear. Scientific evidence has shown that a correlation between pain severity and stage of endometriosis rarely occurs, whereas there is a significant correlation between pain and the presence of deep endometriosis. Onset and intensity of pain may be due to a complex process involving central sensitization and peripheral activation of nociceptive pathways as well as dysfunction of the immune system and of the hypothalamic-pituitary-adrenal (HPA) axis. A deeper understanding of these different pathogenetic mechanisms may improve future treatments in women with painful endometriosis.
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Affiliation(s)
- Luisa Masciullo
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria F Viscardi
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ilaria Piacenti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sara Scaramuzzino
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandra Cavalli
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria G Piccioni
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria G Porpora
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy -
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14
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Chumduri C, Turco MY. Organoids of the female reproductive tract. J Mol Med (Berl) 2021; 99:531-553. [PMID: 33580825 PMCID: PMC8026429 DOI: 10.1007/s00109-020-02028-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
Healthy functioning of the female reproductive tract (FRT) depends on balanced and dynamic regulation by hormones during the menstrual cycle, pregnancy and childbirth. The mucosal epithelial lining of different regions of the FRT-ovaries, fallopian tubes, uterus, cervix and vagina-facilitates the selective transport of gametes and successful transfer of the zygote to the uterus where it implants and pregnancy takes place. It also prevents pathogen entry. Recent developments in three-dimensional (3D) organoid systems from the FRT now provide crucial experimental models that recapitulate the cellular heterogeneity and physiological, anatomical and functional properties of the organ in vitro. In this review, we summarise the state of the art on organoids generated from different regions of the FRT. We discuss the potential applications of these powerful in vitro models to study normal physiology, fertility, infections, diseases, drug discovery and personalised medicine.
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Affiliation(s)
- Cindrilla Chumduri
- Department of Microbiology, University of Würzburg, Biocenter, Würzburg, Germany.
- Max Planck Institute for Infection Biology, Berlin, Germany.
| | - Margherita Y Turco
- Department of Pathology, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research, Cambridge, UK.
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15
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Sachedina A, ABU Bakar M, Dunford AM, Morris A, NUR Azurah AG, Grover SR. Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management. J Obstet Gynaecol Res 2020; 47:352-358. [DOI: 10.1111/jog.14532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Aalia Sachedina
- Department of Gynaecology The Royal Children's Hospital Melbourne Victoria Australia
| | - Mardiha ABU Bakar
- General Practice Creswick and Clunes Medical Centre Melbourne Victoria Australia
| | - Angela M. Dunford
- Department of Gynaecology and Women's Health John Hunter Hospital Newcastle New South Wales Australia
| | - Amanda Morris
- Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology & Reproductive Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Abdul Ghani NUR Azurah
- Department of Obstetrics and Gynaecology Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Sonia R. Grover
- Department of Gynaecology The Royal Children's Hospital Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
- Department of Paediatrics University of Melbourne Melbourne Victoria Australia
- Murdoch Children's Research Institute Melbourne Victoria Australia
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16
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Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci 2020; 14:590823. [PMID: 33132854 PMCID: PMC7573391 DOI: 10.3389/fncel.2020.590823] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Endometriosis is a chronic and debilitating condition affecting ∼10% of women. Endometriosis is characterized by infertility and chronic pelvic pain, yet treatment options remain limited. In many respects this is related to an underlying lack of knowledge of the etiology and mechanisms contributing to endometriosis-induced pain. Whilst many studies focus on retrograde menstruation, and the formation and development of lesions in the pathogenesis of endometriosis, the mechanisms underlying the associated pain remain poorly described. Here we review the recent clinical and experimental evidence of the mechanisms contributing to chronic pain in endometriosis. This includes the roles of inflammation, neurogenic inflammation, neuroangiogenesis, peripheral sensitization and central sensitization. As endometriosis patients are also known to have co-morbidities such as irritable bowel syndrome and overactive bladder syndrome, we highlight how common nerve pathways innervating the colon, bladder and female reproductive tract can contribute to co-morbidity via cross-organ sensitization.
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Affiliation(s)
- Jessica Maddern
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Luke Grundy
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Joel Castro
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Stuart M. Brierley
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, North Terrace Campus, Adelaide, SA, Australia
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17
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Capezzuoli T, Vannuccini S, Mautone D, Sorbi F, Chen H, Reis FM, Ceccaroni M, Petraglia F. Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence. Reprod Biomed Online 2020; 42:451-456. [PMID: 33277193 DOI: 10.1016/j.rbmo.2020.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
RESEARCH QUESTION How effective is medical hormonal treatment in preventing endometriosis recurrence and in improving women's clinical symptoms and quality of life? DESIGN This observational cross-sectional study evaluated the effects of hormonal medical treatment (progestins, gonadotrophin-releasing hormone analogues or continuous oral contraceptives) on endometriosis recurrence, current clinical symptoms and quality of life in three groups of patients: Group A (n = 34), no hormonal treatment either before or after the first endometriosis surgery; Group B (n = 76), on hormonal treatment after the first endometriosis surgery; and Group C (n = 75), on hormonal treatment both before and after the first endometriosis surgery. RESULTS Group C patients were characterized by a lower rate of endometriosis reoperation (P = 0.011) and a lower rate of dysmenorrhoea (P = 0.006). Women who experienced repetitive endometriosis surgery showed worse physical (P = 0.004) and mental (P = 0.012) status than those who received a single surgery, independent of the treatment. CONCLUSION Hormonal treatments represent a valid cornerstone of endometriosis management and may be useful as an alternative to surgery, but also before surgery, to plan better, and after surgery in order to reduce the risk of recurrence. Medical counselling is very helpful in choosing the correct and individualized endometriosis treatment. In fact, the gold standard for modern endometriosis management is the individualized approach and surgery should be considered, depending on the clinical situation and a patient's symptoms.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy
| | - Silvia Vannuccini
- Obstetrics and Gynecology, Department of Maternity and Infancy, AOU Careggi Florence, Italy; Department of Molecular and Developmental Medicine, University of Siena Siena, Italy
| | - Daniele Mautone
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negar di Valpolicella, Verona, Italy
| | - Flavia Sorbi
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy
| | - Huixi Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Fernando M Reis
- Universidade Federal de Minas Gerais, Division of Human Reproduction, Belo Horizonte, Brazil
| | - Marcello Ceccaroni
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negar di Valpolicella, Verona, Italy
| | - Felice Petraglia
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy.
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18
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Yang F, Liu B, Xu L, Liu H. Age at surgery and recurrence of ovarian endometrioma after conservative surgery: a meta-analysis including 3125 patients. Arch Gynecol Obstet 2020; 302:23-30. [PMID: 32430756 PMCID: PMC7266855 DOI: 10.1007/s00404-020-05586-3] [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: 12/26/2019] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the association between age at surgery and recurrence rate of endometrioma. Data sources PubMed, Embase, and the Cochrane Library were searched up to October 2019. METHODS We determined the pooled relative risk (RR) and 95% confidence intervals (CIs) to assess the relationship between age at surgery and the recurrence rate of endometrioma after surgery. Begg's funnel plot and Egger's linear regression was used to assess any publication bias. RESULTS A total of 3125 patients from 10 studies were finally enrolled in this meta-analysis. The recurrence rate decreased with increasing age (RR = 0.93, 95% CI = 0.91-0.95, P = 0.451). Subgroup analysis demonstrated that the pooled RR was 0.926 (95% CI 0.906-0.947, P < 0.001) for a cut-off < 35, and 0.886 (95% CI 0.775-1.040, P = 0.14) for a cut-off ≥ 35. Begg's funnel plot and Egger's linear regression test showed no evidence of publication bias. CONCLUSION This meta-analysis suggested that younger age might be a high-risk factor for the recurrence of ovarian endometrioma after conservative surgery.
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Affiliation(s)
- Fang Yang
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China
| | - Baoqin Liu
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China
| | - Lin Xu
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China
| | - Hong Liu
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China.
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19
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Alhayo S, Leonardi M, Lu C, Gosal P, Reid S, Barto W, Condous G. Ultrasound evaluation of pouch of Douglas obliteration and rectal deep endometriosis in women who have had previous combined colorectal and gynaecological laparoscopic surgery for rectal endometriosis: A pilot study. Aust N Z J Obstet Gynaecol 2020; 60:258-263. [DOI: 10.1111/ajo.13112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 12/01/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Sam Alhayo
- Colorectal Surgery Unit Department of General Surgery Nepean Hospital Sydney NSW Australia
| | - Mathew Leonardi
- Acute Gynaecology Early Pregnancy and Advanced Endoscopic Surgery Unit Nepean Hospital Sydney NSW Australia
- Sydney Medical School Nepean University of Sydney Sydney NSW Australia
| | - Chuan Lu
- Department of Computer Sciences University of Aberystwyth Wales UK
| | - Preet Gosal
- Colorectal Surgery Unit Department of General Surgery Nepean Hospital Sydney NSW Australia
| | - Shannon Reid
- Department of Obstetrics and Gynaecology Liverpool Hospital Liverpool NSW Australia
| | - Walid Barto
- Colorectal Surgery Unit Department of General Surgery Nepean Hospital Sydney NSW Australia
| | - George Condous
- Acute Gynaecology Early Pregnancy and Advanced Endoscopic Surgery Unit Nepean Hospital Sydney NSW Australia
- Sydney Medical School Nepean University of Sydney Sydney NSW Australia
- LaSGeG (Laparoscopic Surgery for General Gynaecologists) Sydney NSW Australia
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20
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Gaba N, Gaba S, Gupta M, Singla M, Dua A. Endometriosis at Cesarean Scar Presenting As an Acute Abdomen. Cureus 2020; 12:e7350. [PMID: 32328362 PMCID: PMC7170023 DOI: 10.7759/cureus.7350] [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] [Indexed: 11/05/2022] Open
Abstract
A 30-year-old female presented to the emergency department with severe abdominal pain and vomitings during her premenstrual period. Abdominal imaging revealed a mass originating from the scar of cesarean section extending into the rectus muscle. The cesarean section was performed four years back. Her history was significant for pain at the site of lesion during menses associated with disproportionate nausea. She was managed conservatively and improved. Fine needle aspiration cytology of the lesion established the diagnosis of scar endometriosis, and there was a permanent resolution of symptoms after its resection.
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Affiliation(s)
- Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Saurabh Gaba
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Mandeep Singla
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Ashish Dua
- Radiodiagnosis, Government Medical College and Hospital, Chandigarh, IND
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21
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Bendifallah S, Vesale E, Daraï E, Thomassin-Naggara I, Bazot M, Tuech JJ, Abo C, Roman H. Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:441-451.e2. [DOI: 10.1016/j.jmig.2019.09.791] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/27/2023]
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22
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Medical treatment of endometriosis: is it a choice of the physician? GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.27.1.2020.2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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23
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Singh SS, Gude K, Perdeaux E, Gattrell WT, Becker CM. Surgical Outcomes in Patients With Endometriosis: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:881-888.e11. [PMID: 31718952 DOI: 10.1016/j.jogc.2019.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Among women treated surgically for endometriosis-associated pain, comprehensive data are lacking on the proportions of patients who experience little or no symptom relief, develop recurrent symptoms, or require further surgical treatment for endometriosis. The aim of this study was to assess the efficacy of surgical procedures used to treat endometriosis-associated pain. METHODS Medline and Embase were searched on October 13, 2016. Articles referring to women undergoing surgery for the treatment of endometriosis-associated pain were screened by two independent investigators. For each included treatment arm, data were extracted for the proportion of patients reporting partial or no improvement after surgery for endometriosis-associated pain, pain recurrence, or requirement for further surgery. RESULTS A total of 38 studies were included. Most studies did not report relevant outcomes to evaluate pain (71.1%) and recurrent surgery (68.4%). Of the women who underwent lesion excision, 11.8% reported no improvement in pain, and 22.6% underwent further surgery. Postoperative pain, recurrent pain, and adverse events were reported by 34.3%, 28.7%, and 14.8%, respectively, of patients who underwent excision or ablation of endometriosis combined with pelvic denervation and in 25.0%, 15.8%, and 8.1% of women who underwent lesion excision alone. Of the patients who were treated surgically for deep endometriosis affecting the bowel and/or bladder, 7.0% experienced recurrent symptoms, and 4.1% underwent further surgery. CONCLUSION This review supports the findings of previous studies and highlights the need for standardized reporting and more detailed follow-up after surgery for endometriosis-associated pain.
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Affiliation(s)
- Sukhbir S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital & University of Ottawa, Ottawa, ON.
| | - Kerstin Gude
- Global Pharmacovigilance, Bayer AG, Berlin, Germany
| | | | - William T Gattrell
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, United Kingdom; Department of Mechanical Engineering and Mathematical Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Christian M Becker
- Endometriosis Care and Research (CaRe) Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Vannuccini S, Reis FM, Coutinho LM, Lazzeri L, Centini G, Petraglia F. Surgical treatment of endometriosis: prognostic factors for better quality of life. Gynecol Endocrinol 2019; 35:1010-1014. [PMID: 31155975 DOI: 10.1080/09513590.2019.1616688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The present study investigated the effect of surgical treatment of endometriosis on physical and mental health. We undertook a prospective survey including 153 premenopausal women with histological diagnosis of endometriosis. The Short Form 12 (SF-12) questionnaire comprising physical and mental component scales was used. Two groups of patients were distinguished: Group A (n = 42) with SF-12 scores above the median in both physical and mental scales; Group B (n = 111) with SF-12 scores below the median in either physical or mental scale. Group A was diagnosed and operated for endometriosis for the first time at an older age (30 vs. 26 years), had undergone more frequently a single surgical intervention (64% vs. 46%), was less affected by symptom or lesion recurrence and had reported less intense current pain symptoms than Group B. Having the first endometriosis surgery at a later age was an independent predictor of better health status (adjusted odds ratio 1.146 per year, 95% confidence interval 1.058-1.242) after accounting for the potential confounding effects of reoperation, pelvic pain and time elapsed since the first surgery. In conclusion, patients with endometriosis who had a single surgery at an older age have good symptom control and better quality of life (QoL).
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Affiliation(s)
- Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital , Florence , Italy
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora , Juiz de Fora , Brazil
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital , Florence , Italy
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Guerra A, Daraï E, Osório F, Setúbal A, Bendifallah S, Loureiro A, Thomassin-Naggara I. Imaging of postoperative endometriosis. Diagn Interv Imaging 2019; 100:607-618. [DOI: 10.1016/j.diii.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022]
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Knox B, Ong YC, Bakar MA, Grover SR. A longitudinal study of adolescent dysmenorrhoea into adulthood. Eur J Pediatr 2019; 178:1325-1332. [PMID: 31292729 DOI: 10.1007/s00431-019-03419-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 12/17/2022]
Abstract
Dysmenorrhoea is the most common gynaecological symptom in adolescents. Secondary dysmenorrhoea is mostly due to endometriosis. There are no known follow-up studies of dysmenorrhoea into adulthood. Cases of endometriosis often have a long history of dysmenorrhea; however, studies to date have been retrospective. This longitudinal cohort study aimed at analysing the long-term outcomes of dysmenorrhoea and associated rate of endometriosis identified in this cohort. Participants of a study of adolescents seen for dysmenorrhoea were followed-up at an average of 10.24 years. Of those contactable (74), 70 (94.6%) were included. As adults, 19 (27.1%) had slight or no pain with menstruation. Increased age of menarche was found to be associated with no menstrual pain in adulthood (OR 2.10, p = 0.034). No adolescent characteristic studied was found to be associated with severe or very severe dysmenorrhoea as an adult. At follow-up, 13 young women (18.6%) had been diagnosed with endometriosis. All cases of endometriosis were mild. The use of the oral contraceptive pill as an adolescent and feeling an improvement in symptoms with treatment as an adolescent were found to be associated with a diagnosis of endometriosis.Conclusion: These findings are important for counselling adolescents regarding this common presentation. What is Known: •Dysmenorrhoea is the most common gynaecological complaint for adolescents What is New: •Dysmenorrhoea from adolescence resolves in 1 in 4 of young women and no adolescent characteristics predict severe or very severe pain with menstruation in adults. •Only 1 in 5 of women were found to have endometriosis (all mild disease), despite a mean of 10 years of preceding dysmenorrhoea.
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Affiliation(s)
- Benita Knox
- Department Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Melbourne, 3052, Australia
| | - Yi Chen Ong
- Department Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Melbourne, 3052, Australia.,The University of Melbourne, Parkville, Melbourne, Australia
| | | | - Sonia R Grover
- Department Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Melbourne, 3052, Australia. .,The University of Melbourne, Parkville, Melbourne, Australia.
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Kiani K, Rudzitis-Auth J, Scheuer C, Movahedin M, Sadati Lamardi SN, Malekafzali Ardakani H, Becker V, Moini A, Aflatoonian R, Ostad SN, Menger MD, Laschke MW. Calligonum comosum (Escanbil) extract exerts anti-angiogenic, anti-proliferative and anti-inflammatory effects on endometriotic lesions. JOURNAL OF ETHNOPHARMACOLOGY 2019; 239:111918. [PMID: 31034955 DOI: 10.1016/j.jep.2019.111918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Calligonum comosum is a desert plant that is applied in traditional folkloric medicine for the treatment of abnormally heavy or prolonged menstruation and menstrual cramps. Moreover, it has been suggested for the treatment of infertility-causing conditions. Its bioactive chemical constituents inhibit multiple processes, such as angiogenesis, inflammation and invasive tissue growth, which may be beneficial in the therapy of endometriosis. AIM OF THE STUDY We investigated the effects of Calligonum comosum on the development of endometriotic lesions. MATERIALS AND METHODS We evaluated the anti-angiogenic activity of Calligonum comosum ethyl acetate fraction (CCEAF) in different in vitro angiogenesis assays. Moreover, we surgically induced endometriotic lesions in BALB/c mice, which received 50 mg/kg Calligonum comosum total extract (CCTE) or vehicle (control) over 4 weeks. The growth, cyst formation, vascularization and immune cell infiltration of the lesions were assessed with high-resolution ultrasound imaging, caliper measurements, histology and immunohistochemistry. RESULTS CCEAF doses of up to 10 μg/mL did not impair the viability of human dermal microvascular endothelial cells (HDMEC), but dose-dependently suppressed their migration, tube formation and sprouting, indicating a substantial anti-angiogenic effect of CCEAF. Furthermore, CCTE significantly inhibited the growth and cyst formation of developing murine endometriotic lesions when compared to vehicle-treated controls. This was associated with a reduced vascularization, cell proliferation and immune cell infiltration. CONCLUSIONS Our findings show that Calligonum comosum targets multiple, fundamental processes in the pathogenesis of endometriosis, which may be beneficial for the treatment of this common gynecological disorder.
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Affiliation(s)
- Kiandokht Kiani
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Jeannette Rudzitis-Auth
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Claudia Scheuer
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Mansoureh Movahedin
- Anatomical Sciences Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | | | - Hossein Malekafzali Ardakani
- Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vivien Becker
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Aflatoonian
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Seyed Nasser Ostad
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, 66421, Homburg/Saar, Germany.
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Dong S, Zhang J, Zhai F, Zhao X, Qin X. Comparative efficacy and safety of traditional Chinese patent medicine for endometriosis: A Bayesian network meta-analysis protocol. Medicine (Baltimore) 2019; 98:e16473. [PMID: 31335707 PMCID: PMC6709182 DOI: 10.1097/md.0000000000016473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Endometriosis is a common disease of women of childbearing age. In recent years, the incidence of endometriosis has been on the rise. The main clinical manifestations are pelvic pain and infertility. In recent years, traditional Chinese patent medicine (TCMP) has played an important role in the treatment of endometriosis. So far, there is a lack of comparison among all the current common TCPMs for endometriosis. Consequently, it is indispensable to propose a network meta-analysis (NMA) protocol to discuss the strengths and weaknesses of different TCMPs. METHODS We will comprehensively and systematically retrieve the relevant Chinese and English databases from their inceptions to the May 2019. All randomized controlled trials (RCTs) of TCMPs for Endometriosis will be included. Two researchers will independently screen literature, extract data and assess the risk of bias of included studies. We will conduct pairwise meta-analyses and Bayesian network meta-analyses to assess all the available evidence. Data will be analyzed using STATA and WinBUGS software. RESULTS This work will compare and rank the relative efficacy of different TCPMs in the treatment of endometriosis in detail. CONCLUSION The results of this study will provide reliable evidence for the selection of clinical treatment program and guideline development. PROSPERO REGISTRATION NUMBER CRD42019127781.
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Affiliation(s)
| | - Jianwei Zhang
- Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan
| | | | - Xinglong Zhao
- Traditional Chinese Medical Hospital of Tai’an, Tai’an
| | - Xiuyun Qin
- Rizhao Maternal and Child Health Care Hospital, Rizhao, Shandong Province, China
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Flores VA, Vanhie A, Dang T, Taylor HS. Response to Letter to the Editor: "Progesterone Receptor Status Predicts Response to Progestin Therapy in Endometriosis". J Clin Endocrinol Metab 2019; 104:2149. [PMID: 30657936 PMCID: PMC7296127 DOI: 10.1210/jc.2018-02712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/07/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Valerie A Flores
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Arne Vanhie
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Tran Dang
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
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Techatraisak K, Hestiantoro A, Ruey S, Banal-Silao MJ, Kim MR, Seong SJ, Thaufik S, Ahlers C, Shin SY, Lee BS. Effectiveness of dienogest in improving quality of life in Asian women with endometriosis (ENVISIOeN): interim results from a prospective cohort study under real-life clinical practice. BMC WOMENS HEALTH 2019; 19:68. [PMID: 31096979 PMCID: PMC6524261 DOI: 10.1186/s12905-019-0758-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Abstract
Background Dienogest has been shown to substantially improve endometriosis-associated symptoms such as debilitating chronic pelvic pain, and in turn, health-related quality of life (HRQoL). To date, there is no data on patient-reported outcomes reflecting the real-world practice in Asia where endometriosis is a relevant health, social and economic burden. This non-interventional, multi-center, prospective study aims to investigate the influence of dienogest on HRQoL. Methods Asian women received dienogest (2 mg/daily) and were followed for 24 months. The effectiveness of dienogest to improve HRQoL and endometriosis-associated pelvic pain (EAPP) was assessed by patient-reported outcomes. HRQoL, especially the “pain” domain as primary endpoint, was evaluated with the Endometriosis Health Profile-30 (EHP-30) questionnaire. The numeric rating scale served to determine changes in the severity of EAPP. Within the presented interim analysis (data cut-off: 2017-11-27), the mean changes in EHP-30 and EAPP scores from baseline to 6 months upon availability of the data were evaluated. Treatment-emergent adverse events (TEAEs) and bleeding profiles were documented. Results Dienogest therapy decreased EHP-30 scores in all assessed domains (score 0–100, lower scores indicate better HRQoL). Primarily, the “pain” domain was improved in 78.4% of patients. EAPP was reduced (score 0–10, lower scores reflect less pain), highlighted by a mean reduction of the pain score by − 4.5 points. Patients with a higher EAPP score at baseline had an increased response to dienogest (− 6.2 points mean change) compared to patients with low baseline EAPP severity (− 1.4 points mean change). Both surgically and clinically diagnosed patients described comparable pain reduction, as well as women with or without prior treatment. Drug-related TEAEs were documented for 31.5% of patients, with amenorrhoea (5.9%) and metrorrhagia (5.1%) being the most common events. The bleeding pattern was changed upon dienogest, characterized by decreased normal bleeding (84.2 to 28.8%) and increased amenorrhea (3.2 to 42.9%) at 6 months. Conclusion The data indicate an amelioration of HRQoL and EAPP upon dienogest therapy. No new safety signals were observed. Therefore, its use as first-line therapy for long-term management of debilitating and chronic endometriosis-associated pain represents an interesting option that remains to be further investigated. Trial registration Name of registry: Clinical Trials Clinicaltrials.gov registration number: NCT02425462 Registration date: 2015-04-24. Registration timing: prospective.
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Affiliation(s)
- Kitirat Techatraisak
- Department of Obstetrics and Gynecology, Gynecologic Endocrinology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andon Hestiantoro
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Soon Ruey
- Department of Obstetrics and Gynecology, Sabah Women's and Children's Hospital, Kota Kinabalu, Malaysia
| | - Maria Jesusa Banal-Silao
- Department of Obstetrics and Gynecology Reproductive Endocrinology and Fertility, St. Luke's Medical Center, Philippine General Hospital, Metro Manila, Philippines
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, The Catholic University Of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Syarief Thaufik
- Department of Obstetrics and Gynecology, Hermina Pandanaran Hospital, Semarang, Indonesia
| | | | - So Young Shin
- Former employee of Bayer AG, Seoul, Republic of Korea
| | - Byung Seok Lee
- Division of Gynecologic Endocrinology and Infertility, Department of Obstetrics and Gynecology, Severance Hospital,Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
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Comparison of enhanced laparoscopic imaging techniques in endometriosis surgery: a diagnostic accuracy study. Surg Endosc 2019; 34:96-104. [PMID: 31028547 PMCID: PMC6946762 DOI: 10.1007/s00464-019-06736-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/06/2019] [Indexed: 01/09/2023]
Abstract
Background For surgical endometriosis, treatment key is to properly identify the peritoneal lesions. The aim of this clinical study was to investigate if advanced imaging improves the detection rate by comparing narrow-band imaging (NBI), near-infrared imaging with indocyanine green (NIR-ICG), or three-dimensional white-light imaging (3D), to conventional two-dimensional white-light imaging (2D) for the detection of peritoneal endometriotic lesions. Methods This study was a prospective, single-center, randomized within-subject, clinical trial. The trial was conducted at Amsterdam UMC—Location VUmc, a tertiary referral hospital for endometriosis. 20 patients with ASRM stage III–IV endometriosis, scheduled for elective laparoscopic treatment of their endometriosis, were included. During laparoscopy, the pelvic region was systematically inspected with conventional 2D white-light imaging followed by inspection with NBI, NIR-ICG, and 3D imaging in a randomized order. Suspected endometriotic lesions and control biopsies of presumably healthy peritoneum were taken for histological examination. The pathologist was blinded for the method of laparoscopic detection. Sensitivity and specificity rates of the enhanced imaging techniques were analyzed. McNemar’s test was used to compare sensitivity to 2D white-light imaging and Method of Tango to assess non-inferiority of specificity. Results In total, 180 biopsies were taken (117 biopsies from lesions suspected for endometriosis; 63 control biopsies). 3D showed a significantly improved sensitivity rate (83.5% vs. 75.8%, p = 0.016) and a non-inferior specificity rate (82.4% vs. 84.7%, p = 0.009) when compared to 2D white-light imaging. The single use of NBI or NIR-ICG showed no improvement in the detection of endometriosis. Combining the results of 3D and NBI resulted in a sensitivity rate of 91.2% (p < 0.001). Conclusion Enhanced laparoscopic imaging with 3D white light, combined with NBI, improves the detection rate of peritoneal endometriosis when compared to conventional 2D white-light imaging. The use of these imaging techniques enables a more complete laparoscopic resection of endometriosis.
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Robotic single-site endometriosis resection using near-infrared fluorescence imaging with indocyanine green: a prospective case series and review of literature. J Robot Surg 2019; 14:145-154. [DOI: 10.1007/s11701-019-00951-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/23/2019] [Indexed: 01/24/2023]
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van Aken M, Oosterman J, van Rijn T, Woudsma K, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Experimental pain tolerance is decreased and independent of clinical pain intensity in patients with endometriosis. Fertil Steril 2018; 110:1118-1128. [DOI: 10.1016/j.fertnstert.2018.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
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Opoku-Anane J, Tyan P, Klebanoff JS, Clay J, Moawad GN. Postoperative Hormonal Suppression for Prevention of Deeply Infiltrative Endometriosis Recurrence After Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0246-2] [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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Fu JL, Hsiao KY, Lee HC, Li WN, Chang N, Wu MH, Tsai SJ. Suppression of COUP-TFII upregulates angiogenin and promotes angiogenesis in endometriosis. Hum Reprod 2018; 33:1517-1527. [DOI: 10.1093/humrep/dey220] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/16/2018] [Accepted: 05/26/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jhao-Lin Fu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuei-Yang Hsiao
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiu-Chi Lee
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Ning Li
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ning Chang
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Hsing Wu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Obstetrics & Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shaw-Jenq Tsai
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Abstract
Care of the endometriosis patient today can be complex and difficult. Once medical management has been exhausted and symptoms persist patients desire further treatment options. This chapter takes an evidence-based approach at discussion of patient surgcical options for treatment of endometriosis symptoms. Surgical techniques, success rates, patient satisfaction, and risks must be discussed and understood at depth before planning patient surgical intervention. This chapter provides reference to current surgical management options and symptom relief following those interventions.
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Aerts L, Grangier L, Streuli I, Dällenbach P, Marci R, Wenger JM, Pluchino N. Psychosocial impact of endometriosis: From co-morbidity to intervention. Best Pract Res Clin Obstet Gynaecol 2018; 50:2-10. [PMID: 29545113 DOI: 10.1016/j.bpobgyn.2018.01.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/23/2018] [Indexed: 01/03/2023]
Abstract
Endometriosis-associated pelvic pain is a major health concern in women of childbearing age. Controlled studies have shown that endometriosis can adversely affect women and their partners' general psychological well-being, relationship adjustment and overall quality of life. Furthermore, women with endometriosis report significantly more sexual dysfunctions compared to healthy women. Empirical studies indicate that specific psychosocial factors may modulate pain experience, pain-related distress and treatment outcome. Research on psychosexual interventions in endometriosis treatment is limited but shows to be effective in reducing endometriosis-related pain and associated psychosexual outcomes. An individualized, couple-centered, multimodal approach to care, integrating psychosexual and medical management for endometriosis, is thought to be optimal.
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Affiliation(s)
- Leen Aerts
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland
| | - Lorraine Grangier
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland
| | - Isabelle Streuli
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland
| | - Patrick Dällenbach
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland
| | - Roberto Marci
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland
| | - Jean-Marie Wenger
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland
| | - Nicola Pluchino
- Department of Gynaecology & Obstetrics, Geneva University Hospital, 30, bvd de la Cluse, 1205, Genève, Switzerland.
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Cea Soriano L, López-Garcia E, Schulze-Rath R, Garcia Rodríguez LA. Incidence, treatment and recurrence of endometriosis in a UK-based population analysis using data from The Health Improvement Network and the Hospital Episode Statistics database. EUR J CONTRACEP REPR 2017; 22:334-343. [DOI: 10.1080/13625187.2017.1374362] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Lucia Cea Soriano
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Esther López-Garcia
- Department of Preventive Medicine, Public Health and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain
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Saraswat L, Ayansina D, Cooper KG, Bhattacharya S, Horne AW, Bhattacharya S. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG 2017; 125:64-72. [DOI: 10.1111/1471-0528.14793] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- L Saraswat
- Department of Obstetrics and Gynaecology; Aberdeen Royal Infirmary; Aberdeen UK
| | - D Ayansina
- Medical Statistics Team; University of Aberdeen; Aberdeen UK
| | - KG Cooper
- Department of Obstetrics and Gynaecology; Aberdeen Royal Infirmary; Aberdeen UK
| | - S Bhattacharya
- Dugald Baird Centre; University of Aberdeen; Aberdeen UK
| | - AW Horne
- MRC Centre for Reproductive Health; University of Edinburgh; Edinburgh UK
| | - S Bhattacharya
- Division of Applied Health Sciences; University of Aberdeen; Aberdeen UK
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Wu B, Yang Z, Tobe RG, Wang Y. Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost-effectiveness analysis. BJOG 2017; 125:469-477. [PMID: 28613432 DOI: 10.1111/1471-0528.14786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of different strategies, including gonadotropin-releasing hormone agonist (GnRH-a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery. DESIGN Cost-effectiveness analysis from a health care perspective. SETTING A health-resource-limited setting in China. POPULATION Patients who underwent conservative laparoscopic or laparotomic surgery for endometriosis. METHODS A Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output. MAIN OUTCOME MEASURES Quality-adjusted life years (QALYs) gained and costs from a health care perspective. RESULTS The incremental cost-effectiveness ratio of 6-month GnRH-a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one-way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6-month GnRH-a therapy is cost-effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis. CONCLUSION Six months of therapy with GnRH-a can be a highly cost-effective option for the prevention of endometriosis recurrence. TWEETABLE ABSTRACT Gonadotropin-releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
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Affiliation(s)
- B Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Z Yang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - R G Tobe
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Y Wang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Egekvist AG, Marinovskij E, Forman A, Kesmodel US, Riiskjaer M, Seyer-Hansen M. Conservative approach to rectosigmoid endometriosis: a cohort study. Acta Obstet Gynecol Scand 2017; 96:745-750. [DOI: 10.1111/aogs.13094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Anne G. Egekvist
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | | | - Axel Forman
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynecology; Herlev and Gentofte University Hospital; Herlev Denmark
- Institute for Clinical Medicine; University of Copenhagen; Copenhagen Denmark
| | - Mads Riiskjaer
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
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The efficacy of long-term maintenance therapy with a levonorgestrel-releasing intrauterine system for prevention of ovarian endometrioma recurrence. Int J Gynaecol Obstet 2016; 134:256-9. [DOI: 10.1016/j.ijgo.2016.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/02/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022]
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Pluchino N, Wenger JM, Petignat P, Tal R, Bolmont M, Taylor HS, Bianchi-Demicheli F. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update 2016; 22:762-774. [PMID: 27591248 DOI: 10.1093/humupd/dmw031] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sexual function is an important aspect of health and quality of life and is influenced by both medical conditions and health-care interventions, especially when gynecologic disorders are involved. Coital pain is among the main factors that affect sexual functioning, and this symptom is reported by almost half of women suffering from endometriosis. However, sexuality is a complex phenomenon driven by social, psychological and biological/hormonal factors and the presence of endometriosis might further affect domains of sexual function and the quality of a sexual relationship. OBJECTIVE AND RATIONALE The objective of this report is to review the current state of knowledge on the impact that endometriosis and its treatments have on the sexual function of women and their sexual partners. SEARCH METHODS A systematic literature search was performed to identify studies evaluating sexual function in endometriosis patients, and a narrative analysis of results is presented. The review discusses relevant quantitative and qualitative studies analyzing the effect of endometriosis and its hormonal and surgical treatments on measures of sexual function and quality of sexual relationship. OUTCOMES Endometriosis negatively affects different domains of sexual function, and the presence of dyspareunia is not the only determinant of sexual health in these women. Chronic pelvic pain, advanced stages of disease and the presence of physical and mental comorbidities affect sexual function, as well as personality traits and women's expectations. Although a number of studies have evaluated the effect of surgery and hormonal treatment on deep dyspareunia, overall sexual function and quality of the relationship with the partner are often under-investigated. WIDER IMPLICATIONS Multiple clinical and personal determinants affect sexual function in women with endometriosis, with potentially negative consequences on the sexual function of partners and quality of the relationship. Additional prospective and longitudinal investigations are warranted using specific instruments to analyze biopsychosocial variables of sexual pain in endometriosis patients and the effects that actual treatments have on measures of quality of sexual function and relationship.
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Affiliation(s)
- Nicola Pluchino
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland .,Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 New Haven, USA
| | - Jean-Marie Wenger
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
| | - Patrick Petignat
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
| | - Reshef Tal
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 New Haven, USA
| | - Mylene Bolmont
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
| | - Hugh S Taylor
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 New Haven, USA
| | - Francesco Bianchi-Demicheli
- Department of Obstetrics and Gynecology, University Hospital of Geneva, 30, Boulevard de la Cluse, 1211 Geneva, Switzerland
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Vlek SL, Lier MCI, Ankersmit M, Ket JCF, Dekker JJML, Mijatovic V, Tuynman JB. Laparoscopic Imaging Techniques in Endometriosis Therapy: A Systematic Review. J Minim Invasive Gynecol 2016; 23:886-92. [PMID: 27393283 DOI: 10.1016/j.jmig.2016.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 02/05/2023]
Abstract
Endometriosis is a common disease associated with pelvic pain and subfertility. Laparoscopic surgical treatment has proven effective in endometriosis, but is hampered by a high rate of recurrence. The aim of this systematic review was to evaluate the intraoperative identification of endometriosis by enhanced laparoscopic imaging techniques, focusing on sensitivity and specificity. A systematic review was conducted according to PRISMA guidelines in PubMed, Embase, Cochrane Library, and Web of Science. Published prospective studies reporting on enhanced laparoscopic imaging techniques during endometriosis surgery were included. General study characteristics and reported outcomes, including sensitivity and specificity, were extracted. Nine studies were eligible for inclusion. Three techniques were described: 5-ALA fluorescence (5-ALA), autofluorescence (AFI), and narrow-band imaging (NBI). The reported sensitivity of 5-ALA and AFI for identifying endometriosis ranged from 91% to 100%, compared with 48% to 69% for conventional white light laparoscopy (WL). A randomized controlled trial comparing NBI + WL with WL alone reported better sensitivity of NBI (100% vs 79%; p < .001). All 9 studies reported an enhanced detection rate of endometriotic lesions with enhanced imaging techniques. Enhanced imaging techniques are a promising additive for laparoscopic detection and treatment of endometriosis. The 5-ALA, AFI, and NBI intraoperative imaging techniques had a better detection rate for peritoneal endometriosis compared with conventional WL laparoscopy. None of the studies reported clinical data regarding outcomes. Future studies should address long-term results, such as quality of life, recurrence, and need for reoperation.
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Affiliation(s)
- Stijn L Vlek
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands.
| | - M C I Lier
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - M Ankersmit
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C F Ket
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - J J M L Dekker
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands; Endometriosis Center, VU University Medical Center, Amsterdam, The Netherlands
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Soliman AM, Bonafede M, Farr AM, Castelli-Haley J, Winkel C. Analysis of subsequent surgery rates among endometriosis patients who underwent surgery with and without concomitant leuprolide acetate therapy. Curr Med Res Opin 2016; 32:1073-82. [PMID: 27027333 DOI: 10.1185/03007995.2016.1159189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To compare subsequent endometriosis-related surgery following initial laparoscopy among women treated with leuprolide acetate (LA) or other endometriosis therapies versus women who received no pharmacotherapy. Research design and methods This retrospective cohort analysis utilized MarketScan Commercial claims data. Women with endometriosis aged 18-49 who underwent laparoscopy between 1 January 2005 and 31 December 2011 were identified using diagnosis and procedures codes and were categorized into four cohorts based on claims within 90 days of laparoscopy: surgery plus adherent LA, surgery plus non-adherent LA, surgery plus other therapy, and surgery alone. Patients with proportion of days covered ≥0.80 in the 6 months after laparoscopy were considered adherent to LA. Main outcome measures Subsequent endometriosis-related surgery (laparoscopy, laparotomy or other excision/ablation/fulguration of endometriosis lesions, oophorectomy, or hysterectomy) was measured in the 6 and 12 months following initial laparoscopy. Risk of subsequent surgery was compared using multivariable Cox proportional hazards modeling. Results Most women were treated with surgery only (n = 9865); fewer were treated with LA (adherent: n = 202; non-adherent: n = 490) or other therapies (n = 230). The proportion of patients with subsequent surgery ranged from 2.0% to 10.0% during the 6 month follow-up (12 month: 9.7% to 13.5%). Adherent LA use was associated with significantly lower risk of surgery compared to surgery alone (hazard ratio [HR] = 0.31, p = 0.020) while use of other therapies was associated with significantly higher risk (HR = 1.51, p = 0.045) over the 6 month follow-up. There was no significant difference between the surgery plus non-adherent LA and surgery only cohort over 6 months (p = 0.247). The association between adherent LA and subsequent surgery was not significant over the 12 month follow-up. Conclusion Therapy with LA after laparoscopy for endometriosis was associated with lower risk of subsequent surgery at 6 months among women who were adherent to LA. Key limitations include lack of ability to capture disease severity which may have resulted in uncontrolled confounding.
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Affiliation(s)
- Ahmed M Soliman
- a Health Economics and Outcomes Research, Abbvie , North Chicago , IL , USA
| | | | | | | | - Craig Winkel
- c Georgetown University School of Medicine , Washington , DC , USA
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Soliman AM, Bonafede M, Farr AM, Castelli-Haley J, Winkel C. Analysis of Adherence, Persistence, and Surgery Among Endometriosis Patients Treated with Leuprolide Acetate Plus Norethindrone Acetate Add-Back Therapy. J Manag Care Spec Pharm 2016; 22:573-87. [PMID: 27123918 PMCID: PMC10397813 DOI: 10.18553/jmcp.2016.22.5.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Endometriosis affects over 10 million women in the United States. Depot leuprolide acetate (LA), a gonadotropin-releasing hormone agonist, has been used extensively for the treatment of women with endometriosis but is associated with hypoestrogenic symptoms and bone mineral density loss. The concomitant use of add-back therapies, specifically norethindrone acetate (NETA), can alleviate these adverse effects. OBJECTIVE To compare adherence to and persistence with LA treatment and time to endometriosis-related surgery among women treated with NETA and women treated with LA plus other add-back therapies or LA only. METHODS This retrospective analysis was conducted using Truven Health MarketScan Commercial Claims and Encounters Database. Women with a diagnosis of endometriosis (ICD-9-CM code 617.xx) who initiated LA (index date) in 2005-2011 were selected for inclusion. Additional requirements were 12 months of continuous enrollment pre- and post-index and no evidence of endometriosis-related surgeries pre-index or up to 30 days post-index; no pre-index use of estrogen or noncontraceptive hormones; and no diagnoses of uterine fibroids, malignant neoplasms, infertility, or pregnancy. Patients were characterized as using NETA; other add-back therapies (estrogens, progestins, or estrogen-progestin combinations); or no add-back therapy. Adherence to and persistence with LA were measured over the 6 months following the index date using outpatient medical and pharmacy claims. Patients were considered adherent if their proportion of days covered was greater than or equal to 0.80. Persistence was operationalized as time to discontinuation, defined as a continuous gap of > 60 days without LA on hand. Time to endometriosis-related surgery (laparotomy, laparoscopy, excision/ablation/fulguration, oophorectomy, and hysterectomy) was measured over the 12 months following the index date. Surgeries were identified from inpatient and outpatient medical claims using procedure codes. Outcomes were compared among cohorts using multivariable logistic and Cox proportional hazards regression models controlling for demographics and baseline clinical characteristics. RESULTS The final sample included 3,114 women, with a mean age of 36.9 years. The majority of women used LA only with no add-back therapy (n = 1,963, 63.0%), while 15.1% (n = 470) used NETA, and 21.9% (N = 681) used other add-back therapies. During the 6-month follow-up, more patients in the LA plus NETA cohort were adherent to LA therapy compared with LA only (47.2% vs. 31.5%, P < 0.001), and fewer patients discontinued (37.9% vs. 59.6%, P < 0.001). Additionally, fewer patients underwent endometriosis-related surgery in the 12 months after LA initiation in the LA plus NETA cohort (12.6% vs. 16.9%, P = 0.021). In multivariable models, women who initiated LA plus NETA or LA plus other add-back therapies had a higher likelihood of being adherent to LA than LA only patients (OR = 1.91, 95% CI = 1.55-2.36 and OR = 1.95, 95% CI = 1.63-2.34) and lower likelihood of LA discontinuation (HR = 0.54, 95% CI = 0.46-0.63 and HR = 0.59, 95% CI = 0.52-0.68). NETA patients had a lower surgery rate in the 12-month post-index period compared with other add-back patients (HR = 0.68, 95% CI = 0.50-0.93) or LA only patients (HR = 0.69, 95% CI = 0.52-0.92). CONCLUSIONS For women with endometriosis, treatment with LA and concomitant add-back therapies was associated with better adherence to and persistence with LA over the 6 months following initiation, compared with treatment with LA only. The increased adherence and persistence to LA may translate into decreased need for surgical intervention, although fewer endometriosis-related surgeries were only observed in the 12 months following LA initiation for patients using concomitant NETA add-back therapy. These results support an increased and earlier use of NETA add-back therapy among women who initiate LA. DISCLOSURES This study was funded by AbbVie, which also markets the endometriosis drugs Lupron and Lupaneta Pack. AbbVie participated in the study design, research, data collection, analysis and interpretation, writing, review, and approval of this publication. Soliman and Castelli-Haley are employees of AbbVie and may own AbbVie stock or stock options. Bonafede and Farr are employees of Truven Health Analytics, which received a research contract to conduct this study with and on behalf of AbbVie. Winkel is a clinical professor in the Department of Obstetrics and Gynecology at Georgetown University in Washington, DC, and has served in a consulting role on research to AbbVie for this project. An earlier version of the current research was presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 20th Annual International Meeting; Philadelphia, PA; May 2015. All authors participated in data analysis and interpretation and contributed to the development of the manuscript.
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Can postoperative GnRH agonist treatment prevent endometriosis recurrence? A meta-analysis. Arch Gynecol Obstet 2016; 294:201-7. [DOI: 10.1007/s00404-016-4085-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
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Eggers JC, Martino V, Reinbold R, Schäfer SD, Kiesel L, Starzinski-Powitz A, Schüring AN, Kemper B, Greve B, Götte M. microRNA miR-200b affects proliferation, invasiveness and stemness of endometriotic cells by targeting ZEB1, ZEB2 and KLF4. Reprod Biomed Online 2016; 32:434-45. [PMID: 26854065 DOI: 10.1016/j.rbmo.2015.12.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 02/06/2023]
Abstract
Endometriosis is characterized by growth of endometrial tissue at ectopic locations. Down-regulation of microRNA miR-200b is observed in endometriosis and malignant disease, driving tumour cells towards an invasive state by enhancing epithelial-to-mesenchymal transition (EMT). miR-200b up-regulation may inhibit EMT and invasive growth in endometriosis. To study its functional impact on the immortalized endometriotic cell line 12Z, the stromal cell line ST-T1b, and primary endometriotic stroma cells, a transient transfection approach with microRNA precursors was employed. Expression of bioinformatically predicted targets of miR-200b was analysed by qPCR. The cellular phenotype was monitored by Matrigel invasion assays, digital-holographic video microscopy and flow cytometry. qPCR revealed significant down-regulation of ZEB1 (P < 0.05) and ZEB2 (P < 0.01) and an increase in E-cadherin (P < 0.01). miR-200b overexpression decreased invasiveness (P < 0.0001) and cell motility (P < 0.05). In contrast, cell proliferation (P < 0.0001) and the stemness-associated side population phenotype (P < 0.01) were enhanced following miR-200b transfection. These properties were possibly due to up-regulation of the pluripotency-associated transcription factor KLF4 (P < 0.05) and require attention when considering therapeutic strategies. In conclusion, up-regulation of miR-200b reverts EMT, emerging as a potential therapeutic approach to inhibit endometriotic cell motility and invasiveness.
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Affiliation(s)
- Julia C Eggers
- Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany
| | - Valentina Martino
- Institute of Biomedical Technologies, National Research Council, 20090 Segrate-Milan, Italy
| | - Rolland Reinbold
- Institute of Biomedical Technologies, National Research Council, 20090 Segrate-Milan, Italy
| | - Sebastian D Schäfer
- Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany
| | - Anna Starzinski-Powitz
- Institute of Anthropology and Human Genetics for Biologists, Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany
| | - Andreas N Schüring
- Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany
| | - Björn Kemper
- Biomedical Technology Center, University of Muenster, 48149 Muenster, Germany
| | - Burkhard Greve
- Klinik für Strahlentherapie - Radioonkologie, Universitätsklinikum Münster, D-48149 Münster, Germany.
| | - Martin Götte
- Department of Gynecology and Obstetrics, Münster University Hospital, D-48149 Münster, Germany.
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Robin B, Planeix F, Sastre-Garau X, Pichon C, Olesen TK, Gogusev J, Ghinea N. Follicle-Stimulating Hormone Receptor Expression in Endometriotic Lesions and the Associated Vasculature: An Immunohistochemical Study. Reprod Sci 2015; 23:885-91. [PMID: 26704526 DOI: 10.1177/1933719115623647] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Follicle-stimulating hormone receptor (FSHR) is present on endothelial cells of blood vessels and endometrial glands of the proliferative and secretory endometrium. So far, the expression of FSHR in endometriosis has not been studied. We evaluated FSHR expression in 194 tissue specimens representing 3 relevant types of endometriosis: rectovaginal endometriotic nodules, ovarian endometriotic cysts, and peritoneal endometriotic implants. Specimens of normal endometrium were used as controls. Archival formalin-fixed and paraffin-embedded material was analyzed immunohistochemically with a highly specific monoclonal antihuman FSHR antibody using the peroxidase method. A robust vascular FSHR expression was found in all 194 patients, irrespective of the endometriosis lesion location. Follicle-stimulating hormone receptor was not detected in normal host tissues located more than 5 mm from the lesions. The endometriotic lymphatic vessels do not express FSHR. The density of FSHR-positive vessels in patients with rectovaginal endometriotic nodules was 46.0 ± 5.7 vessels/mm(2) Similar values were obtained for ovarian endometriotic cysts and peritoneal endometriosis. The density of FSHR-positive vessels associated with the core of rectovaginal endometriotic nodules was 2-fold higher than that of the perilesional, adjacent normal host tissue (64.2 ± 8.2 vs 27.2 ± 3.2 vessels/mm(2), respectively). Expression of FSHR was also detected either in endometriotic glandular epithelial cells, endometriotic stromal cells, or in both cell types (23%, 25%, and 21% of patients, respectively). Normal endometrium expressed FSHR predominately in basalis, in a cellular distribution dependent on hormonal environment. In conclusion, our data suggest novel FSHR expression in endometriotic lesions, qualitatively and quantitatively different from that of normal endometrium.
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Affiliation(s)
- Blaise Robin
- INSERM-Tumoral Angiogenesis, Translational Research Department, Institut Curie, Paris, France
| | - François Planeix
- INSERM-Tumoral Angiogenesis, Translational Research Department, Institut Curie, Paris, France
| | | | - Christophe Pichon
- INSERM-Tumoral Angiogenesis, Translational Research Department, Institut Curie, Paris, France
| | - Tine Kold Olesen
- International PharmaScience Center, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Jean Gogusev
- Cochin Institute, Inserm U1016, CNRS 8104, Université Paris Descartes, Paris, France Université Paris Descartes, DHU Risques et Grossesse, Paris, France
| | - Nicolae Ghinea
- INSERM-Tumoral Angiogenesis, Translational Research Department, Institut Curie, Paris, France
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Yun BH, Jeon YE, Chon SJ, Park JH, Seo SK, Cho S, Choi YS, Lee JS, Lee BS. The Prognostic Value of Individual Adhesion Scores from the Revised American Fertility Society Classification System for Recurrent Endometriosis. Yonsei Med J 2015; 56:1079-86. [PMID: 26069133 PMCID: PMC4479838 DOI: 10.3349/ymj.2015.56.4.1079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrence of endometriosis after conservative laparoscopy. MATERIALS AND METHODS As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosis at Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperative serum CA-125 levels were retrospectively analyzed to assess their prognostic values for recurrence of endometriosis. RESULTS Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8±6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovarian cysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116-7.789), p=0.029]. CONCLUSION Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesion score was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significance in affecting recurrence in the current study.
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Affiliation(s)
- Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Eun Jeon
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Joo Chon
- Department of Obstetrics and Gynecology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Joo Hyun Park
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - SiHyun Cho
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Department of Obstetrics and Gynecology, Gil Hospital, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea.
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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