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Soares M, Luyckx M, Maillard C, Laurent P, Gerday A, Jadoul P, Squifflet J. Outcomes after Laparoscopic Excision of Bladder Endometriosis Using a CO 2 Laser: A Review of 207 Cases in a Single Center. J Minim Invasive Gynecol 2023; 30:52-60. [PMID: 36280201 DOI: 10.1016/j.jmig.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVE Assess efficacy, safety, fertility outcomes and recurrence after laparoscopic resection of bladder endometriosis (BE) using a CO2 laser. DESIGN Retrospective cohort study. SETTINGS University gynecologic surgery unit, referral center for endometriosis. PATIENTS A total of 207 women having undergone laparoscopic BE excision between January 1998 and January 2019. INTERVENTIONS None. MAIN OUTCOME MEASURES Intra- and postoperative complication rates. Disease recurrence and fertility outcomes in patients with a minimum 1-year follow-up (n = 176) for "isolated" and "non-isolated" BE groups. RESULTS Forty-three patients presented with isolated BE. Bladder "shaving" without mucosae opening was performed in 50.7% cases. No intraoperative complications were noted. One postoperative grade 3 complication was related to BE excision: a bladder breach requiring closure by repeat laparoscopy. Mean (± SD) follow-up was 7.05 (± 4.65) years. In patients wishing to conceive (n = 132), the total pregnancy rate (PR) was 75% (48.5% spontaneous), 76.19% in the isolated BE group (56.3% spontaneous). Among the 94 patients with previous infertility, 74.5% conceived, 50% spontaneously. No statistical difference was found in PR and need for in vitro fertilization between isolated and nonisolated BE groups. BE recurrence rate was 3.4%. No difference was observed between groups with full-thickness bladder resection (4/88) and shaving (2/88) (p = .406). Age at surgery (hazard ratio 0.91 [0.84-0.98], p = .016) and postoperative pregnancy (hazard ratio 0.07 [0.01-0.91], p = .042) showed influence on disease recurrence. CONCLUSIONS The study demonstrates that laparoscopic BE removal is feasible with very low complications rates and was associated with high PR (both spontaneous and in vitro fertilization), even in patients with previous infertility. BE recurrence is lower than for other endometriosis locations. Bladder endometriosis; Laparoscopy; Deep infiltrating endometriosis; Fertility; Partial bladder resection.
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Affiliation(s)
- Michelle Soares
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Brussels IVF, University Hospital Brussels (Dr. Soares).
| | - Mathieu Luyckx
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Institute of experimental and clinical research (IREC), Catholic University of Louvain, Belgium (Drs. Luyckx, Gerday, Jadoul, and Squifflet); TILS group - de Duve Institute, Catholic University of Louvain, Belgium (Dr. Luyckx)
| | - Charlotte Maillard
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet)
| | - Pauline Laurent
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet)
| | - Amandine Gerday
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Institute of experimental and clinical research (IREC), Catholic University of Louvain, Belgium (Drs. Luyckx, Gerday, Jadoul, and Squifflet)
| | - Pascale Jadoul
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Institute of experimental and clinical research (IREC), Catholic University of Louvain, Belgium (Drs. Luyckx, Gerday, Jadoul, and Squifflet)
| | - Jean Squifflet
- Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Institute of experimental and clinical research (IREC), Catholic University of Louvain, Belgium (Drs. Luyckx, Gerday, Jadoul, and Squifflet)
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Meligy FY, Elgamal DA, Abdelzaher LA, Khashbah MY, El-Mokhtar MA, Sayed AA, Refaiy AM, Othman ER. Adipose tissue-derived mesenchymal stem cells reduce endometriosis cellular proliferation through their anti-inflammatory effects. Clin Exp Reprod Med 2021; 48:322-336. [PMID: 34875740 PMCID: PMC8651762 DOI: 10.5653/cerm.2021.04357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/23/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Endometriosis is a chronic debilitating inflammatory condition characterized by the presence of endometrial tissues outside the uterine cavity. Pelvic soreness and infertility are the usual association. Due to the poor effectiveness of the hormone therapy and the high incidence of recurrence following surgical excision, there is no single effective option for management of endometriosis. Mesenchymal stem cells (MSCs) are multipotent stromal cells studied for their broad immunoregulatory and anti-inflammatory properties; however, their efficiency in endometriosis cases is still a controversial issue. Our study aim was to evaluate whether adipose tissue-derived MSCs (AD-MSCs) could help with endometriosis through their studied anti-inflammatory role. Methods Female Wistar rats weighting 180 to 250 g were randomly divided into two groups: group 1, endometriosis group; established by transplanting autologous uterine tissue into rats’ peritoneal cavities and group 2, stem cell treated group; treated with AD-MSCs on the 5th day after induction of endometriosis. The proliferative activity of the endometriosis lesions was evaluated through Ki67 staining. Quantitative estimation of interferon γ, tumor necrosis factor-α, interleukin (IL)-6, IL-1β, IL-10, and transforming growth factor β expression, as well as immunohistochemical detection of CD68 positive macrophages, were used to assess the inflammatory status. Results The size and proliferative activity of endometriosis lesions were significantly reduced in the stem cell treated group. Stem cells efficiently mitigated endometriosis associated chronic inflammatory reactions estimated through reduction of CD68 positive macrophages and the expression of the proinflammatory cytokines. Conclusion Stem cell therapy can be considered a novel remedy in endometriosis possibly through its anti-inflammatory and antiproliferative properties.
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Affiliation(s)
- Fatma Y Meligy
- Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia A Elgamal
- Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Lobna A Abdelzaher
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Maha Y Khashbah
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A El-Mokhtar
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayat A Sayed
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abeer M Refaiy
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Essam R Othman
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Wattier JM. [Conventional analgesics and non-pharmacological multidisciplinary therapeutic treatment in endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:248-255. [PMID: 29510963 DOI: 10.1016/j.gofs.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/24/2022]
Abstract
A major symptom of endometriosis is pelvic pain with a wide range of intensity, rhythm, type, and expression, without clearly established relationship between pain and the disease. Endometriosis-associated pain has physical, psychological/behavioral and social consequences with a significant impact on patient quality-of-life in relation with the biopsychosocial model of chronic pain. Pain assessment in all of its dimensions, as well as assessing the consequences of pain is therefore a crucial part of therapeutic management. Conventional analgesics are commonly used although studies demonstrating their efficacy in the treatment of endometriosis-related pelvic pain are lacking. Non-steroid anti-inflammatory drugs (NSAIDs), known to be effective in dysmenorrhea unrelated to endometriosis, have not been recently re-assessed in patients with endometriosis. Following rigorous assessment, the characterization of neuropathic components of endometriosis-related pelvic pain may lead to treatment with antiepileptic of antidepressant drugs, although gabapentin and amitriptyline have yet to be specifically assessed in the setting of endometriosis-related pain. Other pharmacologically active compounds have been tested to treat endometriosis-related pain but did not demonstrate efficacy with sufficient level of evidence. Diets, dietary supplements and herbal medicine are often proposed and/or used as adjuncts without any conclusive evidence. Although the effects on endometriosis-related pain are methodologically difficult to assess, physical adjunctive therapies such as acupuncture, transcutaneous neurostimulation, osteopathy/chiropractics, physical therapy and physical activity, the long-term therapeutic relationship they establish may potentiate beneficial effects perceived by patients. However, it remains difficult to demonstrate significant effects of cognitive and/or behavioral interventions on endometriosis-related pain. CONCLUSION The complexity of managing endometriosis-related pain requires a holistic approach with sustained attention to the patient. Treatments, either pharmacologic or non-pharmacologic, including adjuvant therapies, associate a technical expertise to which a human approach must be added in order to bring value to these treatments. Multidisciplinary and/or inter disciplinary approaches are therefore essential to the care of patients suffering from endometriosis.
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Affiliation(s)
- J-M Wattier
- Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
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Fauconnier A, Aubry G, Fritel X. Bladder Endometriosis: A Rare but Challenging Condition. Eur Urol 2017; 71:808-810. [PMID: 28129892 DOI: 10.1016/j.eururo.2017.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 01/06/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France; Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University, Montigny-le-Bretonneux, France.
| | - Gabrielle Aubry
- Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University, Montigny-le-Bretonneux, France
| | - Xavier Fritel
- INSERM CIC802, Poitiers University, University Hospital of Poitiers, Poitiers, France
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Urman B, Ata B, Arslan T, Aksu S, Taskiran C. Parasitic Myomas and an Adenomyoma Obstructing the Ureter After Power Morcellation of Myomas and Endometriotic Nodule Resection. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:362-5. [PMID: 27208606 DOI: 10.1016/j.jogc.2016.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/13/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The use of power morcellation (PM) in abdominal and pelvic surgery has been discouraged and even banned in some institutions because of the risk of spreading malignant cells, although some authorities maintain that PM can be an appropriate tool for selected patients deemed to be at low risk of malignancy. CASE A 42-year-old woman developed parasitic myomas and an adenomyoma obstructing the right ureter after laparoscopic excision of multiple myomas and deep infiltrating endometriosis using PM. Laparoscopic excision of the parasitic myomas and removal of the adenomyoma relieved the obstruction of the ureter. CONCLUSION Although there is reasonable concern about the use of PM spreading malignant disease, benign disease can also be spread by PM and can cause significant complications. Use of PM should be restricted as much as possible.
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Affiliation(s)
- Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Tonguc Arslan
- Women's Health Center, the American Hospital, Istanbul, Turkey
| | - Sertan Aksu
- Women's Health Center, the American Hospital, Istanbul, Turkey
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
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