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Chatroux LR, Einarsson JI. Keep your attention closer to the ureters: Ureterolysis in deep endometriosis surgery. Best Pract Res Clin Obstet Gynaecol 2024; 95:102494. [PMID: 38614884 DOI: 10.1016/j.bpobgyn.2024.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024]
Abstract
Endometriosis surgery involving the ureter poses significant challenges requiring meticulous surgical techniques and vigilant postoperative care. This chapter addresses key aspects of ureterolysis techniques, intraoperative management of ureteral injuries, and postoperative care in the context of endometriosis surgery. Ureterolysis methods aim to isolate and mobilize the ureter while preserving its vascularity. Cold instruments and careful dissection are recommended to prevent thermal injury during surgery. Intraoperative tools such as indocyanine green (ICG) show promise in assessing for vascular compromise. Over half of ureteral injuries are detected postoperatively, necessitating a high index of suspicion. Optimal postoperative care in the case of ureteral injury involves Foley catheterization for decompression, ureteral stenting, and meticulous follow-ups to monitor healing and renal function. While advances have been made in surgical techniques and diagnostic tools, gaps persist in preoperative imaging optimization and predictive models for identifying at-risk patients. This chapter aims to bridge existing knowledge gaps, optimize surgical practices, and enhance the overall care and outcomes of patients undergoing endometriosis surgery involving the ureter.
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Affiliation(s)
- Louisa R Chatroux
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Jon I Einarsson
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA
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Neme GL, Guimarães CTS, Dantas PP, Santana DDB, Yamauchi FI, Filho HML, Bittencourt LK, Pereira RMA, Mattos LA. Postoperative Imaging of Endometriosis. Radiographics 2024; 44:e230159. [PMID: 38512726 DOI: 10.1148/rg.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Glaucy L Neme
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Patricia P Dantas
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Daniel D B Santana
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Fernando I Yamauchi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Hilton M Leão Filho
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leonardo K Bittencourt
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Ricardo M A Pereira
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leandro A Mattos
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
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Chway C, Flórez S, Muñoz MD, Guerriero S, Alcázar JL. The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:7-19. [PMID: 37792527 DOI: 10.1002/jum.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The aim of this study is to determine the accuracy of transvaginal ultrasound (TVU) for the diagnosis of ureteral involvement in women with deep infiltrating endometriosis (DIE). METHODS The meta-analysis included primary studies comparing the use of TVU for diagnosing endometriotic involvement of the ureter, using laparoscopic surgery and histological diagnosis as the reference standard. Search was performed in several databases (Scopus, Web of Science, and PubMed/MEDLINE). The studies' quality and bias risk were assessed using the Quality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2). Diagnostic performance was estimated by assessing pooled sensitivity and specificity. RESULTS A total of 496 citations were found. Six articles were ultimately selected for this systematic review and meta-analysis after the inclusion and exclusion criteria were applied. Pooled sensitivity and specificity were 0.81 (95% CI: 0.42-0.96), 1.00 (95% CI: 0.93-1.00). The heterogeneity observed was high for both sensitivity and specificity. Overall risk of bias was low. CONCLUSION TVU is a valuable tool for the pre-operative identification of ureteral involvement by DIE.
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Affiliation(s)
- Cizar Chway
- Faculty of Medicine, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Sandra Flórez
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Maria Dolores Muñoz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria - Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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Aublé A, Gazdovich S, Dégremont S, Pfister C, Roman H, Bridoux V, Leroi AM, Cornu JN. Evaluation of the efficacy of sacral neuromodulation in the treatment of voiding dysfunction after endometriosis surgery. Prog Urol 2023; 33:1073-1082. [PMID: 37951811 DOI: 10.1016/j.purol.2023.10.003] [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: 08/28/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
Pelvic surgery for endometriosis is associated with a risk of bladder and digestive sequelae. Sacral neuromodulation (SNM) has been shown to be effective in the treatment of overactive bladder (OAB) and voiding dysfunction (VD). This study aimed to evaluate the efficacy of sacral neuromodulation (SNM) in treating voiding dysfunction (VD) following endometriosis surgery. A retrospective analysis was conducted on data from women who underwent SNM testing for persistent VD after endometriosis surgery. The study included 21 patients from a French tertiary referral center. Patient characteristics, lower urinary tract symptoms, urodynamic findings, SNM procedures, and outcomes were assessed. The primary outcome was the success of SNM treatment for VD. After a median follow-up of 55 months, 60% of patients achieved successful outcomes, with significant improvements of VD and quality of life. Moreover, more than half of patients who required clean intermittent self-catheterization (CISC) before SNM were able to wean off CISC. Complications such as infections and paraesthesia were observed, but overall, SNM was found to be effective and well tolerated. Age and the interval between endometriosis surgery and SNM testing were associated with treatment success. This study adds to the limited existing literature on SNM for VD after endometriosis surgery and suggests that SNM can be a valuable therapeutic option for these patients. Further research is needed to identify predictive factors and mechanisms underlying the effectiveness of SNM in this context. MRI-compatible and rechargeable devices, has improved the feasibility of SNM for these patients. In conclusion, SNM offers promise as a treatment option for persistent VD after endometriosis surgery, warranting further investigation. LEVEL OF EVIDENCE: 4.
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Affiliation(s)
- Annabelle Aublé
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, Rouen, France; Physiology Department, Rouen University Hospital, Rouen, France; Department of Pediatric Surgery, University of Rouen, Rouen, France.
| | - Stéphanie Gazdovich
- Department of Urology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Stéphane Dégremont
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - Christian Pfister
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - Horace Roman
- Endometriosis Center, clinique Tivoli-Ducos, Bordeaux, France
| | - Valérie Bridoux
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, Rouen, France
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Rocha MA, Mendes G, Castro LF, Mesquita S, Teixeira BL, Madanelo M, Vital JA, Marques-Monteiro M, Vinagre N, Oliveira B, Magalhães M, Príncipe P, Ferreira H, Silva-Ramos M. Outcomes of Urinary Tract Endometriosis-Laparoscopic Treatment: A 10-Year Retrospective Study. J Clin Med 2023; 12:6996. [PMID: 38002610 PMCID: PMC10672564 DOI: 10.3390/jcm12226996] [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: 09/15/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre's experience with UTE. METHODS We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012-2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored. RESULTS The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis. CONCLUSIONS Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition.
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Affiliation(s)
- Maria Alexandra Rocha
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Gonçalo Mendes
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Luis Ferreira Castro
- Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (L.F.C.); (H.F.)
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Bernardo Lobão Teixeira
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - João Aragão Vital
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Miguel Marques-Monteiro
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Nuno Vinagre
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Beatriz Oliveira
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Martinha Magalhães
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Paulo Príncipe
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Hélder Ferreira
- Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (L.F.C.); (H.F.)
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
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Lecointre L, Buttignol M, Faller E, Boisrame T, Martel C, Host A, Gabriele V, Akladios C. Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort. Eur J Obstet Gynecol Reprod Biol 2023; 288:204-210. [PMID: 37572449 DOI: 10.1016/j.ejogrb.2023.07.015] [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: 04/16/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION The proximity of the urinary tract to the female genital tract explains its possible involvement in pelvic gynaecological cancer or deep endometriosis. Surgical treatment is aimed at improving overall survival and recurrence-free survival of patients, as well as restoring normal anatomy and functional integrity depending on the pathology. These operations are accompanied by significant post-operative complications. Thus, the urological procedures performed must be rigorously justified, and the different resection and reconstruction techniques adapted to the pathology and the level of infiltration. OBJECTIVE To describe the activity profile, over the last ten years, of a gynaecological surgery department in terms of urological procedures in the management of patients with deep endometriosis and pelvic carcinology. STUDY DESIGN This is a monocentric retrospective observational study, including all patients who underwent a urological procedure by a gynaecological surgeon only, as part of the management of pelvic gynaecological cancers or deep endometriosis, at the University Hospital Centre (CHU) of Strasbourg, between January 1st 2010 and April 31st 2021. The variables studied were early postoperative complications, the rate of surgical reintervention, operating time, length of hospital stay, the need for peri-operative drainage or transfusion, and post-operative functional disorders. RESULTS A total of 86 patients were included, 27 in the pelvic gynaecological cancer group and 59 in the deep endometriosis group. 61.6% of patients received uretero-vesical catheterization, 60.5% partial cystectomy, 10.5% psoic bladder ureteral reimplantation, and 3.5% trans-ileal Bricker skin ureterostomy. The mean operating time was 316 min in the pelvic gynaecological cancer group and 198.9 min in the deep endometriosis group. The average hospital stay was 11.5 days, 22.3 days for patients treated for pelvic cancer and 6.3 days for those treated for endometriosis. The rate of minor post-operative complications was 8.2% of cases, and major post-operative complications 17.4% of cases, the majority of which were in the gynecological cancer group. There were no cases of intra- or early post-operative death. Early postoperative urinary complications affected 14.0% of the total patients, mostly in the gynaecological cancer group with 33.3% of patients, but only 5.1% of patients in the deep endometriosis group. The total reoperation rate within 60 days postoperatively was 15.1%, 40.7% for patients treated for gynaecological cancer and 3.4% for those treated for deep pelvic endometriosis. The rate of reoperations for urinary complications was 11.6% of total patients, or 76.9% of total reoperations. 15 patients received labile blood products intra- or postoperatively, 11 in the pelvic gynaecological cancer group and 4 in the endometriosis group. CONCLUSION Our overall results appear comparable to those reported in the literature and are particularly satisfactory in terms of post-operative complications after partial cystectomy in the management of deep endometriosis compared to other gynaecological departments. This work encourages us to continue and improve the training of gynaecological surgeons in terms of multidisciplinary surgical procedures, including urological ones, to obtain a global vision of the pathology and to allow an optimal quality of care for the patients.
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Affiliation(s)
- Lise Lecointre
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France; Insitute of Image-Guided Surgery, IHU-Strasbourg (Institut Hospitalo-Universitaire), 1 place de l'Hôpital, 67000 Strasbourg, France; ICube UMR 7357 - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, Université de Strasbourg, Strasbourg, France.
| | - Megane Buttignol
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Emilie Faller
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Thomas Boisrame
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Camille Martel
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Aline Host
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France
| | - Victor Gabriele
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Chérif Akladios
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
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Alenezi S, Zaheer M, Khudair S. Intrinsic unilateral ureteral endometriosis: A rare case report. Int J Surg Case Rep 2023; 104:107966. [PMID: 36889152 PMCID: PMC10015228 DOI: 10.1016/j.ijscr.2023.107966] [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: 01/20/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Ureteral endometriosis is a rare disease and it has variable and subtle clinical presentation and often it lead to delayed diagnosis and worse outcome. CASE PRESENTATION Here we present a 44-year-old married lady who presented with dull aching right iliac fossa pain. CT urography right moderate hydro-uretero nephrosis with a suspicion of a mass in the lower right ureter. Diagnostic rigid ureteroscopy showed completely intraluminal polypoidal pedunculated right lower ureteral mass with near total occlusion of the lumen, which was excised completely by Ho: Yag laser. Histopathology confirmed pure endometriosis tissue with no ureteral tissue. Follow up showed no recurrence of the mass, however eventually the patient developed deterioration in kidney function due to the long-standing undiscovered obstruction. CLINICAL DISCUSSION Ureteral endometriosis can cause silent obstruction for a long time. Surgical intervention has different modalities according to the type of U.E, and it is the appropriate treatment method for U.E causing complete obstruction to preserve kidney function. CONCLUSION Ureteral endometriosis is a rare but should be included in the differential diagnosis of premenopausal women with ureteral obstruction of unknown cause. Early intervention is critical for better outcomes.
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Affiliation(s)
- Saad Alenezi
- Urology Department, Jaber Alahmad Hospital, Kuwait.
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Frumkin N, Schmädecker R, Isermann R, Keckstein J, Ulrich UA. Surgical Treatment of Deep Endometriosis. Geburtshilfe Frauenheilkd 2023; 83:79-87. [PMID: 36643873 PMCID: PMC9833890 DOI: 10.1055/a-1799-2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023] Open
Abstract
In deep endometriosis (DE), clusters of endometrium-like cells penetrate more than 5 mm below the peritoneum: The affected organs and tissue structures can eventuate in an alteration of the anatomy with eliminated organ boundaries, which in some cases can pose a real surgical challenge, even for experienced surgeons. A comprehensive description of the different manifestations of the disease can be found in the #Enzian classification. Since the operation is usually the foundation for the successful treatment of DE, what is important are conclusive indications, appropriate preoperative preparation and, above all, appropriate experience on the part of the surgical team. This article aims to provide a review of the surgical options that are currently available.
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Affiliation(s)
- Nora Frumkin
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Rasmus Schmädecker
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Ricarda Isermann
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Jörg Keckstein
- Endometriosezentrum Ordination Dres. Keckstein, Villach, Austria
| | - Uwe Andreas Ulrich
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany,Korrespondenzadresse Prof. Dr. Uwe Andreas Ulrich 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther
Krankenhaus, Johannesstift DiakonieCaspar-Theyß-Str. 27–3114193
BerlinGermany
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9
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Kim J, Boo Y, Lee CU, Ko KJ, Chung JH, Sung HH, Baek M, Jeon SS, Han DH. Effects of hormone therapy on the clinical outcomes of endoscopic intervention in patients with endometriosis-related ureteral obstruction. Investig Clin Urol 2023; 64:13-19. [PMID: 36629061 PMCID: PMC9834571 DOI: 10.4111/icu.20220224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We investigated whether endoscopic interventions, including laser endoureterotomy and balloon dilatation following hormone therapy, are a good choice to treat ureteral obstruction due to ureteral endometriosis instead of laparoscopic or open surgery. MATERIALS AND METHODS Patients with ureteral obstruction due to endometriosis who underwent endoscopic intervention between 2004 and 2021 were reviewed. Patients with other causes of ureteral obstruction or previous ureteral surgery were excluded from the study. The primary endpoint was the 3-month success rate of endoscopic intervention with or without hormone therapy. Secondary endpoints were the success rate of endoscopic intervention between the hormone-treated and hormone-untreated groups at 6 months and the success rate according to the hormone therapy response of endometriosis at 3 and 6 months. RESULTS Eighteen patients with 19 ureter units were evaluated in this study, including 12 patients receiving hormone therapy and six patients not receiving hormone therapy. Among patients receiving hormone therapy, one patient had bilateral ureteral obstruction. The success rate of endoscopic intervention was higher in patients who received hormone therapy than in those who did not receive hormone therapy three months after endoscopic intervention (76.9% vs. 0.0%, p=0.003). The same result was also found 6 months after endoscopic intervention (75.0% vs. 0.0%, p=0.005). In addition, the success rates were higher in the hormone-responsive group than in the non-responsive group (100.0% vs. 57.1%), although the difference was not statistically significant (p=0.122). CONCLUSIONS Ureteral obstruction caused by endometriosis can be effectively treated by endoscopic intervention with hormone therapy in select patients.
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Affiliation(s)
- Jungyu Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngjun Boo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Alborzi S, Askary E, Poordast T, Alborzi S, Abadi AKH, Shoaii F. Approach to ureteral endometriosis: A single-center experience and meta-analysis of the literature. J Obstet Gynaecol Res 2023; 49:75-89. [PMID: 36268633 DOI: 10.1111/jog.15449] [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: 06/20/2022] [Revised: 09/03/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM To report single-center outcomes of laparoscopic management of patients with ureteral endometriosis and perform a meta-analysis in order to select the best approach for these patients. METHODS The cross-sectional study was conducted during a 6-year period (2015-2021) in the referral endometriosis center on 353 patients with ureteral endometriosis. For the meta-analysis, 10 articles, including 505 patients, were found to be eligible. In our meta-analysis, as well as our study, all endometriosis-related pain symptoms and complications of surgery were evaluated, analyzed, and reported. RESULTS Of the 326 patients whose ureteral involvement was confirmed in pathology, hydronephrosis and intrinsic ureteral lesions were detected in only 10.76% and 3.1% of the patients. Mean operating time and hospitalization were 3.25 ± 1.83 h and 86 ± 2.58 days, respectively. The most common site of concomitant involvement with endometriosis was uterosacral ligament (92.9%) and rectosigmoid (70.53%). Type II and III of Cliven-Dindo complications were seen in 5.66% and 1.13% of patients, respectively. During a follow-up period, no evidence of bladder or ureteral re-involvement was observed. Similar to our meta-analysis, all endometriosis-related pain decreased significantly following operation (p ≤ 0.001). In our meta-analysis, the rate of ureteral endometriosis recurrence, stenosis/stricture, bladder atonia, urinary tract infection, hematuria, and fistula formation after surgery were: 2.0% (I2 : 50.42%), 15.0% (I2 : 0.00%), 14.0% (I2 : 8.76%), 6.0% (I2 : 0.00%), 7.0% (I2 : 79.28%), and 2.0% (I2 : 0.0%), respectively. CONCLUSION The laparoscopic resection of the UE could be suggested as a feasible and safe method associated with favorable functional outcomes.
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Affiliation(s)
- Saeed Alborzi
- Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University Of Medical Sciences, Shiraz, Iran
| | - Soroosh Alborzi
- Student Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alimohammad K H Abadi
- Clinical Research Development Center of Nemazee Hospital, Department of Statistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Shoaii
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University Of Medical Sciences, Shiraz, Iran
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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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Martire FG, Russo C, Selntigia A, Siciliano T, Lazzeri L, Piccione E, Zupi E, Exacoustos C. Transvaginal ultrasound evaluation of the pelvis and symptoms after laparoscopic partial cystectomy for bladder endometriosis. J Turk Ger Gynecol Assoc 2022; 23:145-153. [PMID: 36065973 PMCID: PMC9450928 DOI: 10.4274/jtgga.galenos.2022.2022-5-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate transvaginal sonography (TVS) findings after laparoscopic partial cystectomy for bladder endometriosis and to correlate postsurgical ultrasound findings with symptoms. Material and Methods: A retrospective study including women who underwent laparoscopic partial cystectomy for bladder endometriosis. Within 12 months after surgery, TVS examination was conducted in all patients to evaluate the bladder morphology, and the presence of any postsurgical sonographic findings of the pelvis. Painful symptoms were assessed using a visual analogue scale. Results: A total of 40 women were included. At the follow-up visit, 25 patients were receiving medical treatment while 15 had declined post-surgical therapy and had tried to conceive. The presence of bladder deep-infiltrating endometriosis (DIE) was found in nine (22.5%), fibrotic thickening of the bladder wall was found in 15 (37.5%), and normal bladder morphology was observed in 16 (40%). There was a correlation between anterior adenomyosis and bladder DIE, and fibrotic thickening of the bladder. Patients with TVS signs of bladder DIE and anterior adenomyosis suffered more dysmenorrhea and dysuria than patients with normal bladder. Conclusion: Post-operative TVS can detect the alteration of pelvis and could explain the causes of the persistence of symptoms.
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Affiliation(s)
- Francesco Giuseppe Martire
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Consuelo Russo
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Aikaterini Selntigia
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Terry Siciliano
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Emilio Piccione
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy,Postgraduate School of Obstetrics and Gynecology, Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
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13
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'Guess who'? An Italian multicentric study on pigmentation traits prevalence in endometriosis localizations. Eur J Obstet Gynecol Reprod Biol 2022; 274:5-12. [PMID: 35561567 DOI: 10.1016/j.ejogrb.2022.05.001] [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: 03/29/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Previous evidence seems to support the more common presence of certain pigmentation types in women with endometriosis. The aim of this study was to assess the association of certain somatic phenotypes with specific localizations of the disease. The genetic makeup of those somatic traits may will help in better define the disease pathogenesis. STUDY DESIGN Multicentric, retrospective study of women aged 18 to 45 with histologically confirmed endometriosis. 575 patients were recruited at eleven different Italian endometriosis clinics from March 2015 to January 2021. Data regarding clinical and surgical features were recorded following the self-administered endometriosis patient questionnaire and the surgical standard of reports approved by the World Endometriosis Research Foundation (WERF). Pigmentation types/somatic phenotypes frequencies among endometriosis localizations were reported. A logistic regression analysis was performed to determine somatic types independently associated with disease' localizations. RESULTS Having green eyes increased by ∼4 folds (OR 3.7; 95% CI: 1.42-9.61; p = 0.007) the risk of having a ureteral nodule, whereas brown/black eyes decreased this risk (OR 0.34; 95% CI: 0.13-0.87; p = 0.025). Consistently, the combination of green eyes and blonde/light brown hairs increased the odds of ureteral endometriosis by more than 5 folds (OR 5.40; 95%CI: 2.02-14.49; p = 0.001), even after correction for anthropometric confounders (aOR 5.85; 95% CI: 2.13-16.09; p < 0.001). CONCLUSIONS The association between endometriosis and pigmentary traits has been herein confirmed, with the novel finding of the possible predisposition of ureteral endometriosis in patients with green eyes and blonde/light brown hairs. Further investigation on the genetic makeup of somatic traits may provide new inroads also into the molecular aspects of endometriosis leading to a better understanding of this complex disease.
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14
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Guan Z, Soni SD, Zhou J, Sunkara S, Guan X. Cystoscopic-Guided Robotic Resection of Bladder Trigone Endometriosis Nodule with Ureteral Preservation. J Minim Invasive Gynecol 2022; 29:930-931. [PMID: 35618233 DOI: 10.1016/j.jmig.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Zhenkun Guan
- Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China..
| | - Samit D Soni
- Urology Section, Memorial Hermann Medical Group, Houston, TX, U.S.A
| | - Jerry Zhou
- Department of Urology, Baylor College of Medicine, Houston, TX, U.S.A
| | - Sowmya Sunkara
- Division of Minimally Invasive Gynecological Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Xiaoming Guan
- Division of Minimally Invasive Gynecological Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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15
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Ochi T, Kurihara M, Tsuboshima K, Nonaka Y, Kumasaka T. Dynamics of thoracic endometriosis in the pleural cavity. PLoS One 2022; 17:e0268299. [PMID: 35544515 PMCID: PMC9094567 DOI: 10.1371/journal.pone.0268299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis. Methods In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively. Results The cohort median age was 41 (range 22–53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6–1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively. Conclusions Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.
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Affiliation(s)
- Takahiro Ochi
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
- * E-mail:
| | - Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Yuto Nonaka
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
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16
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Accuracy of transvaginal ultrasound and magnetic resonance imaging for diagnosis of deep endometriosis in bladder and ureter: a meta-analysis. J OBSTET GYNAECOL 2022; 42:2272-2281. [PMID: 35421318 DOI: 10.1080/01443615.2022.2040965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This meta-analysis aimed to determine the accuracy of transvaginal ultrasound (TVS) and pelvic magnetic resonance imaging (MRI) in diagnosing urinary tract endometriosis (UTE). A comprehensive search of the Pubmed and Embase was conducted between January 1989 and June 2020. Studies that described the accuracy of MRI or TVS for the diagnosis of UTE using surgical data as the reference standard were included. Of the 913 citations identified, 23 studies were analysed. For detection of endometriosis in bladder endometriosis (BE), the overall pooled sensitivities of TVS and MRI were 72% and 68% respectively, and their specificities were 99% and 100% respectively. For detection of endometriosis in the ureteral endometriosis (UE), the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%. In conclusion, both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective. Besides, pelvic MRI and TVS are more accurate for predicting UTE localised in the ureter than bladder, especially in terms of sensitivity.IMPACT STATEMENTWhat is already known on this subject? Previous studies have confirmed high diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) on bladder endometriosis (BE) respectively. However, high heterogeneity was found for both sensitivity and specificity and no meta-analysis has yet been performed to test the diagnostic value of TVS and MRI for ureteral endometriosis (UE).What the results of this study add? In this meta-analysis, we firstly confirmed high diagnostic value of TVS and MRI on UE respectively. For detection of UE, the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%.What the implications are of these findings for clinical practice and/or further research? Early preoperative diagnosis and accurate understanding of the widespread distribution of endometriosis are prerequisites for radical surgical in UTE. In the present study, we updated the previous results on the accuracy of TVS and MRI for the diagnosis of BE and firstly confirmed high diagnostic value of TVS and MRI on UE. Both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective.
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Barbanti C, Labanca L, Gentile F, Chini T, Centini G, Habib N, Zupi E, Lazzeri L. Urinary-tract endometriosis: a multidisciplinary fight against a silent enemy. J Minim Invasive Gynecol 2022; 29:584-585. [PMID: 35247606 DOI: 10.1016/j.jmig.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To demonstrate the safety and feasibility of laparoscopic robotic assisted approach to urinary tract endometriosis. DESIGN This is an educational video to explain the main steps of robotic assisted ureteroneocystostomy due to endometriosis. SETTING Tertiary care university hospital. Patient written consent was obtained on 9th March 2021. The local IRB confirmed that the video met the ethical criteria. INTERVENTIONS Laparoscopic Robotic assisted resection of uterosacral ligament endometriotic nodule, left terminal partial ureterectomy, partial cystectomy and ureteroneocystostomy. CONCLUSION This video shows a stepwise approach to laparoscopic robotic assisted urinary tract endometriosis management demonstrating its feasibility and safety. Urinary-tract endometriosis affect only the 0,3% to 6% of women affected by endometriosis, amongst which the most common localization is the bladder (84-90%) [1]. The ureteral compression is rare but can lead to obstruction up to silent loss of renal function [2], which is one of the main factors to take into account in the management of this disease [3].
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Affiliation(s)
- Chiara Barbanti
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
| | - Luca Labanca
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
| | - Filippo Gentile
- Azienda Ospedaliera Universitaria Senese, U.O.C. Urology, Siena (Drs. Filippo and Tommaso), Italy
| | - Tommaso Chini
- Azienda Ospedaliera Universitaria Senese, U.O.C. Urology, Siena (Drs. Filippo and Tommaso), Italy
| | - Gabriele Centini
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy.
| | - Nassir Habib
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy (Dr. Habib), France
| | - Errico Zupi
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
| | - Lucia Lazzeri
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
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18
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Lertvikool S, Tingthanatikul Y, Hongsakorn W, Srisombut C, Nakpalat K, Weerakiet S. Outcomes of Laparoscopic Partial Cystectomy of Bladder Endometriosis: A Report of 18 Thai Women. WOMEN'S HEALTH REPORTS 2021; 2:369-374. [PMID: 34671756 PMCID: PMC8524725 DOI: 10.1089/whr.2021.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Aim: To determine the outcomes of laparoscopic partial cystectomy (LPC) for bladder endometriosis (BE). Methods: This was a retrospective study using medical records of women who underwent LPC for BE between January 2009 and December 2017. Demographic characteristics, surgical findings, including surgical site and size of the bladder lesion, endometriosis at other locations, and pre- and postoperative hormonal treatment data were collected. Results: We analyzed data of 18 women with full-thickness BE. The patients had a mean age of 34 (range, 26–45) years and body mass index of 21.6 (range, 16.1–25) kg/m2. All women had dysmenorrhea. Other symptoms noted include dysuria, gross hematuria, and infertility. BE with a mean diameter of 2.7 cm (range, 1–5) was most commonly found at the posterior wall of the bladder (94.4%). Peritoneal endometriosis (94.4%), endometrioma (33.3%), and deep endometriotic nodules (22.2%) in the posterior compartment were also found. No surgical complications were observed. Postoperative hormonal treatment was administered to 14 (77.8%) patients. All symptoms improved after the surgery. No recurrence was found after 30 (range, 12–74) months of follow-up. Conclusion: LPC is an effective treatment option for BE.
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Affiliation(s)
- Srithean Lertvikool
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Tingthanatikul
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Woradej Hongsakorn
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chartchai Srisombut
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Katanyuta Nakpalat
- Women Health Centre, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhon Royal Academy, Bangkok, Thailand
| | - Sawaek Weerakiet
- Division of Obstetrics and Gynecology, Bangkok Hospital Udonthani, Udonthani, Thailand
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19
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Nguyen DB, Arendas K, Jago CA, Warren J, Singh SS. Stepwise approach to the laparoscopic excision of bladder endometriosis. Fertil Steril 2021; 117:225-227. [PMID: 34663509 DOI: 10.1016/j.fertnstert.2021.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a stepwise approach to the laparoscopic excision of bladder endometriosis. DESIGN Narrated surgical video. SETTING Academic tertiary care hospital. PATIENT(S) Surgical footage was obtained from three patients who underwent surgery for bladder endometriosis. Institutional review board approval was not required in accordance with the Tri-Council Policy Statement of Canada, article 2.5. INTERVENTION(S) Laparoscopic excision of bladder endometriotic nodules by partial cystectomy. MAIN OUTCOME MEASURE(S) Overview of the relevant anatomy, disease overview, surgical planning and perioperative care, and the approach to the excision of bladder endometriotic nodules. RESULT(S) The approach to excision of bladder endometriotic nodules can be standardized in six reproducible steps: cystoscopy with or without ureteral stent placement; abdominal survey and treatment of posterior compartment disease; bladder mobilization; partial bladder cystectomy under cystoscopic guidance; cystotomy closure; and water-leak test. CONCLUSION(S) The safe and complete excision of bladder endometriosis relies on the understanding of surgical anatomy, the multidisciplinary aspect of patient care, and the standardization of the surgical approach.
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Affiliation(s)
- Dong Bach Nguyen
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Campus, Montreal, Quebec; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario; Faculty of Medicine, University of Ottawa, Ottawa, Ontario.
| | - Kristina Arendas
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario; Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Caitlin A Jago
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario; Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Jeffrey Warren
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario; Department of Urology, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada
| | - Sukhbir S Singh
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario; Faculty of Medicine, University of Ottawa, Ottawa, Ontario
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20
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Kho Lily CL, Goh C, Lim YK. Isolated Bladder Endometriosis in a Patient With Previous Cesarean Sections. J Med Cases 2021; 11:370-373. [PMID: 34434349 PMCID: PMC8383495 DOI: 10.14740/jmc3543] [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: 07/05/2020] [Accepted: 09/09/2020] [Indexed: 12/04/2022] Open
Abstract
Urological endometriosis is rare and accounts for approximately 1% of women with endometriosis. The pathophysiology of bladder endometriosis may be divided into two different causes, namely primary and secondary. The primary form occurs spontaneously and manifests in a form of a generalized pelvic disease whereas the secondary form is thought to be iatrogenic and typically occurs after pelvic surgery such as Cesarean section or hysterectomy. We present a case report on a patient presenting with an invasive bladder mass initially thought to be from a pelvic malignancy. The final histology showed isolated bladder endometriosis. She had a significant past medical history of two previous Cesarean sections. A review of her magnetic resonance imaging (MRI) images demonstrated the presence of a Cesarean scar niche which may be linked to her bladder endometriosis. There is a need to improve awareness of the possible link between Cesarean scar niche with bladder endometriosis. This is important as it raises the clinical question of whether appropriate repair of Cesarean scar niches can prevent future complications such as bladder endometriosis which can potentially be associated with significant morbidity.
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Affiliation(s)
- Chye Lee Kho Lily
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Charissa Goh
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Yong Kuei Lim
- Timothy Lim Clinic for Women and Cancer Surgery, Mount Alvernia Hospital, Singapore
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21
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Clinical characteristics of urinary tract endometriosis: A one-year national series of 232 patients from 31 endometriosis expert centers (by the FRIENDS group). Eur J Obstet Gynecol Reprod Biol 2021; 264:155-161. [PMID: 34303076 DOI: 10.1016/j.ejogrb.2021.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/06/2021] [Accepted: 06/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review prospectively the clinical characteristics of patients suffering from urinary tract endometriosis (UTE) in France, in 2017. STUDY DESIGN We conducted a prospective observational multicenter study including women managed surgically for UTE in 31 French endometriosis expert centers (FRIENDS group) from January 1, 2017 to December 31, 2017. We distinguished patient with isolated bladder endometriosis ("IBE") or isolated ureteral endometriosis ("IUE") and patients associating both locations (mixed locations "ML"). Surgeons belonging to FRIENDS group enrolled patients by filling a 24 items questionnaire the day of the surgery and 6 weeks later. Data on the locations of UTE, preoperative assessment, urinary symptoms and associated pelvic locations were collected in a single anonymized database. RESULTS A total of 232 patients from 31 centers were included. IBE concerned 82 patients (35.3%), IUE 126 patients (54.4%) ML 24 patients (10.3%). 111 patients reported urinary symptoms (47.8%). IUE was more often asymptomatic than the rest of the locations (59.5% versus 43.3%, OR 1,92, p = 0.017). Associated deep infiltrating endometriosis (DIE) lesions were found in 193 patients (83.1%). IUE was significantly associated with other DIE lesions (82.5% versus 66%, OR2.4, p = 0.006), particularly with rectum or sigmoid nodules (57.1% versus 36.8%, OR 2.3, p = 0.002) and retrocervical space nodules (31.7% versus 19.8%, OR 1.9, p = 0.05). CONCLUSION Our study reports the second largest series of patients operated from a UTE and shows that ureteral location seems more frequent, less symptomatic and more frequently associated to other DIE locations than bladder endometriosis.
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22
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Yang K, Cheng S, Cai Y, Qiao J, Xu Y, Li X, Xiong S, Lu Y, Mei A, Li X, Zhou L. Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases. BMC WOMENS HEALTH 2021; 21:206. [PMID: 34001081 PMCID: PMC8130255 DOI: 10.1186/s12905-021-01349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 05/09/2021] [Indexed: 11/17/2022]
Abstract
Background To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. Methods To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed. Results Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a history of endometriosis. Twenty-one (52%) patients had urological symptoms, and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively. Conclusions Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yukun Cai
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jiankun Qiao
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yangyang Xu
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Ye Lu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Aobing Mei
- Department of Urology, The Second People's Hospital of Guiyang, Guizhou, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
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23
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Surgical Management of Urinary Tract Endometriosis: A 1-year Longitudinal Multicenter Pilot Study at 31 French Hospitals (by the FRIENDS Group). J Minim Invasive Gynecol 2021; 28:1889-1897.e1. [PMID: 33964459 DOI: 10.1016/j.jmig.2021.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To describe the surgical management and risks of postoperative complications of patients with urinary tract endometriosis in France in 2017. DESIGN Multicenter retrospective cohort pilot study. SETTING Departments of gynecology at 31 expert endometriosis centers. PATIENTS All women managed surgically for urinary tract endometriosis from January 1, 2017, to December 31, 2017. We distinguished patients with isolated bladder endometriosis or isolated ureteral endometriosis (IUE) from those with endometriosis in both locations (mixed locations [ML]). INTERVENTIONS Surgeons belonging to the French Colorectal Infiltrating Endometriosis Study (FRIENDS) group enrolled patients who filled a 24-item questionnaire on the day of the inclusion and 3 months later. Data were collected on operative routes, surgical management, and postoperative complications according to the Clavien-Dindo classification in a single anonymized database. MEASUREMENTS AND MAIN RESULTS A total of 232 patients from 31 centers were included. Isolated bladder endometriosis was found in 82 patients (35.3%), IUE in 126 patients (54.4%), and ML in 24 patients (10.3%). Surgery was performed by laparoscopy, laparotomy, or robot-assisted laparoscopy in 74.1%, 11.2%, and 14.7% of the cases, respectively. Among the 150 ureteral lesions (IUE and ML), 114 were managed with ureterolysis (76%), 28 with ureteral resection (18.7%), 4 with nephrectomy (2.7%), and 23 with cystectomy (15.3%). Concerning bladder endometriosis, a partial cystectomy was performed in 94.3% of the cases. We reported 61 postoperative complications (26.3%): 44 low-grade complications according to the Clavien-Dindo classification (18%), 16 grade III complications (7%), and 1 grade IV complication (peritonitis). CONCLUSION The surgical management of ureteral and bladder endometriosis is usually feasible and safe through laparoscopic surgery. Ureteral resection, when necessary, is more strongly associated with laparotomy and with more complications than other procedures. Prospective controlled studies are still mandatory to assess the best surgical management for patients.
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24
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Arena A, Del Forno S, Orsini B, Iodice R, Degli Esposti E, Aru AC, Manzara F, Lenzi J, Raimondo D, Seracchioli R. Ureteral endometriosis, the hidden enemy: multivariable fractional polynomial approach for evaluation of preoperative risk factors in the absence of ureteral dilation. Fertil Steril 2021; 116:470-477. [PMID: 33962769 DOI: 10.1016/j.fertnstert.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether it is possible to predict the risk of ureteral endometriosis (UE) using a mathematical model based on preoperative findings. DESIGN Prospective observational study conducted between January 2017 and April 2020. SETTING Tertiary-level academic referral center. PATIENT(S) Three hundred consecutive women of reproductive age with a diagnosis of posterior deep infiltrating endometriosis (DIE) scheduled for laparoscopic surgery. INTERVENTION(S) Before surgery, anamnestic data and the severity of endometriosis-related symptoms were evaluated, and all patients underwent a complete gynecological examination. Transvaginal and transabdominal ultrasound were performed to map the endometriotic lesion. Ureteral involvement was surgically and histologically confirmed. MAIN OUTCOME MEASURE(S) To select important risk factors for UE and determine a suitable functional form for continuous predictors, we used the multivariable fractional polynomial. RESULTS UE was surgically found in 145 women (48.3%). Based on our multivariable polynomial mathematical model, UE was significantly associated with adenomyosis, parametrial involvement, and previous surgery for endometriosis. A posterior DIE nodule with a transverse diameter >1.8 cm was associated with a higher probability of ureteral involvement. CONCLUSIONS Posterior DIE nodule with a transverse diameter >1.8 cm, adenomyosis, parametrial involvement, and previous surgery for endometriosis appear to be good predictors of UE.
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Affiliation(s)
- Alessandro Arena
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simona Del Forno
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Orsini
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Raffaella Iodice
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Eugenia Degli Esposti
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Chiara Aru
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Manzara
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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25
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Topdağı Yılmaz EP, Yapça ÖE, Aynaoğlu Yıldız G, Topdağı YE, Özkaya F, Kumtepe Y. Management of patients with urinary tract endometriosis by gynecologists. J Turk Ger Gynecol Assoc 2021; 22:112-119. [PMID: 33389930 PMCID: PMC8187977 DOI: 10.4274/jtgga.galenos.2020.2020.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective The aim was to report the postoperative outcomes of urinary tract endometriosis (UTE), which is a form of deep, infiltrative endometriosis, and to contribute to the literature by presenting our experience. Material and Methods In the present study, patients who underwent surgery for endometriosis at our clinic between 2005 and 2019 and had a final pathological diagnosis of UTE were examined in detail. Patient information was retrospectively retrieved from the medical records. Data obtained pre-, peri-, and postoperatively were analyzed. Results Mean age of the 70 patients included, according to the study criteria, was 32.73±7.09 years. Ureteral involvement alone was observed in 49% (n=34) of the patients, bladder involvement alone was observed in 24% (n=17) of the patients, and both bladder and ureteral involvement were observed in 27% (n=19) of the patients. Microscopic hematuria was detected in 16% (n=11) of the patients, whereas preoperative urinary tract findings, such as recurrent urinary tract infections, were detected in 19% patients (n=13). Of the patients, 56% (n=39) were identified with dyspareunia, 56% (n=39) with dysmenorrhea, and 30% (n=21) with pelvic pain. Visual analog scale score was significantly lower after the procedure (p<0.0001). Conclusion Although postoperative results were typically considered positive, surgical method performed in deep infiltrative endometriosis should aim to preserve fertility, improve quality of life, and reduce the complication rate to a minimum.
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Affiliation(s)
| | - Ömer Erkan Yapça
- Department of Obstetrics and Gynecology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | | | - Yunus Emre Topdağı
- Department of Obstetrics and Gynecology, Sanko University Faculty of Medicine, Gaziantep, Turkey
| | - Fatih Özkaya
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Yakup Kumtepe
- Department of Obstetrics and Gynecology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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26
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Abdalla Ribeiro HS, da Costa Porto BT, Bassoi L, Ninomiya GY, Tomasi MC, Cervantes GV, Ribeiro PA. Effect of nodule size on symptoms and the choice of surgical technique in patients with bladder endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520977996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: In this study, we evaluated the relationships between symptoms of bladder endometriosis (EDT), lesion size, and the subsequent surgical technique used to excise the lesion. Methods: This is retrospective observational study of patients who underwent surgery in the Gynecological Endoscopy and Endometriosis Section at Hospital da Santa Casa of São Paulo, Brazil. A sample population of 39 women diagnosed with bladder EDT was included from 463 women presenting with deep pelvic EDT between January 2010 and March 2017. Clinical evaluations and surgical treatments for each EDT were performed. Results: Of the 39 women, 43.58% had dysmenorrhea or dyspareunia and 2.56% had hematuria. Furthermore, 21.10% presented with dysuria and endometriotic nodules on the bladder ( p < 0.04). The nodules had reached the muscle layer in 97.30% of patients, and a further 2.60% had reached the mucosal layer. In addition to bladder involvement, other pelvic regions were affected, including the left (15.8%) and right (13.2%) round ligament, left (68.4%) and right (65.8%) uterosacral ligament, retrocervical region (84.20%), and ureter (45.71%). Conclusion: The patients’ pain symptoms were found to be associated with bladder endometriosis and nodule size. Partial cystectomy with complete lesion excision might be an effective treatment option to relieve these symptoms. A study with a larger sample population is needed to confirm these findings.
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Affiliation(s)
- Helizabet Salomão Abdalla Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Beatriz Taliberti da Costa Porto
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Luisa Bassoi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Mariana C Tomasi
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Graziele V Cervantes
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Paulo Ayroza Ribeiro
- Gynecology and Obstetrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
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27
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Nezhat C, Katler QS. Ureteral endometriosis requiring bilateral ureteroneocystotomy: saving the endangered kidneys. Fertil Steril 2020; 115:98-99. [PMID: 33272633 DOI: 10.1016/j.fertnstert.2020.09.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ceana Nezhat
- Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia
| | - Quinton S Katler
- Reproductive Endocrinology and Infertility Fellow, Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
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28
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Aas-Eng MK, Montanari E, Lieng M, Keckstein J, Hudelist G. Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review. Semin Reprod Med 2020; 38:216-226. [PMID: 33232986 DOI: 10.1055/s-0040-1718740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Imaging of endometriosis and in particular deep endometriosis (DE) is crucial in the clinical management of women facing this debilitating condition. Transvaginal sonography (TVS) is the first-line imaging method and magnetic resonance imaging (MRI) may provide supplemental information. However, the delay in diagnosis of up to 10 years and more is of concern. This problem might be overcome by simple steps using imaging with emphasis on TVS and referral to tertiary care. Finally, TVS is crucial in mapping extent and location of disease in planning surgical therapy and counseling women regarding various therapeutic options. This review presents the available data on imaging of endometriosis with a focus on TVS and MRI for DE, adenomyosis, and ovarian endometriomas including endometriomas in pregnancy as well as the use of "soft markers." The review presents an approach that is in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement.
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Affiliation(s)
- Mee Kristine Aas-Eng
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eliana Montanari
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St. John of God, Vienna, Austria.,Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Marit Lieng
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joerg Keckstein
- Stiftung Endometrioseforschung/Endometriosis Research Group Central Europe
| | - Gernot Hudelist
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St. John of God, Vienna, Austria.,Stiftung Endometrioseforschung/Endometriosis Research Group Central Europe
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29
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Leonardi M, Espada M, Kho RM, Magrina JF, Millischer AE, Savelli L, Condous G. Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment. Diagnostics (Basel) 2020; 10:E771. [PMID: 33007875 PMCID: PMC7650710 DOI: 10.3390/diagnostics10100771] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023] Open
Abstract
We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.
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Affiliation(s)
- Mathew Leonardi
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.E.); (G.C.)
- Nepean Clinical School, University of Sydney, Sydney, NSW 2747, Australia
- Endometriosis Clinic, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8N3Z5, Canada
| | - Mercedes Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.E.); (G.C.)
- Nepean Clinical School, University of Sydney, Sydney, NSW 2747, Australia
| | - Rosanne M. Kho
- Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Javier F. Magrina
- Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Anne-Elodie Millischer
- IMPC Radiology Bachaumont Paris and Radiodiagnostics Department, Hôpital Necker, 75015 Paris, France;
| | - Luca Savelli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, 40126 Bologna, Italy;
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.E.); (G.C.)
- Nepean Clinical School, University of Sydney, Sydney, NSW 2747, Australia
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30
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Wang C, Yang X, Fan Q, Yuan J, Li Y, Wang Y. Feasibility and safety of cryoablation on the porcine ureter using a new balloon cryoprobe. Cryobiology 2020; 96:130-136. [PMID: 32707123 DOI: 10.1016/j.cryobiol.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Cryoablation, as a well-characterized technology, has multifarious clinical applications. But few are reported on ureteral endometriosis. Thus, we examined the feasibility and safety of cryotherapy with a novel balloon cryoprobe on ureter in a live porcine model. During the freezing and thawing cycle, temperature was recorded in different parts of the ureter in real-time. Two-minute cryoablation could induce necrosis within range in 1 cm diameter on serosa layer. The temperature respectively dropped to -136.5 °C, -96.1 °C and -17.5 °C at the cryotherapy center, 1 cm and 1.5 cm from center on serosal side. The ureters were harvested immediately, 2 weeks or 3 months after cryotherapy. No perforation, stricture, adhesions, or hydronephrosis was observed. Histopathologic representations of ureters after cryoablation indicated that full thickness necroses of ureters were seen in all samples. The results demonstrated ureteral cryoablation using a novel balloon probe was feasible, safe, and effective. These findings provided us reference before cryoablation could be applied in clinical practice in treating ureteral endometriosis.
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Affiliation(s)
- Chao Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xiaoming Yang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Qiong Fan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jiangjing Yuan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yuhong Li
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yudong Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China; Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China; Shanghai Key Laboratory of Embryo Original Diseases Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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31
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Agely A, Bolan C, Metcalfe A, VanBuren W, Menias C. Genitourinary manifestations of endometriosis with emphasis on the urinary tract. Abdom Radiol (NY) 2020; 45:1711-1722. [PMID: 31919646 DOI: 10.1007/s00261-019-02383-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common benign condition affecting women. The disease has a broad spectrum of presentations from incidental lesions in asymptomatic women to causing significant and debilitating morbidity in others. Ectopic endometrial glands are located in predictable locations throughout the pelvis, including implantation on the ovaries and in the rectouterine cul-de-sac. Less commonly, the urinary tract may be involved. As genitourinary manifestations may remain symptomatically occult or masquerade as other diagnoses, it is essential for the radiologist to be aware of the imaging features, consider this diagnosis, and potentially save the patient from delayed treatment.
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Affiliation(s)
- A Agely
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - C Bolan
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - A Metcalfe
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - W VanBuren
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - C Menias
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Mabrouk M, Borghese G, Esposti ED, Raimondo D, Remorgida V, Arena A, Zupi E, Mattioli G, Ambrosio M, Seracchioli R. Acute abdominal pain in non-pregnant endometriotic patients: not just dysmenorrhoea. A systematic review. J OBSTET GYNAECOL 2020; 41:7-20. [PMID: 32312121 DOI: 10.1080/01443615.2019.1700946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis, defined as the presence of functional endometrial tissue outside the uterine cavity, presents mainly with pelvic pain and infertility. Acute abdominal pain in non-pregnant patients with endometriosis might be minimised as a typical feature of the disease, while endometriosis is rarely considered in the differential diagnosis of acute abdominal pain. Our objective was to conduct a systematic review of the current literature of cases of acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. We performed a PubMed/MEDLINE search of studies published from January 1990 to December 2018, selecting English language reports and series of non-pregnant patients with acute abdomen and histological confirmation of endometriosis. The studies were revised by two independent authors. Data were abstracted and compiled for analysis. Fifty articles reporting 62 patients were identified. The complications were classified according to anatomical sites in bowel, urinary tract, and genital organs emergencies. Rarely was the first diagnostic hypothesis endometriosis, misdiagnosis was frequent. The time frame from symptoms onset to management was often long. This is the first systematic review evaluating acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. These conditions are rare but possibly life-threating and require prompt diagnosis and emergent medical or surgical treatment.
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Affiliation(s)
- Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cambridge Clinical School, Cambridge, UK
| | - Giulia Borghese
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentino Remorgida
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynaecology, University of Genova, Genova, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Errico Zupi
- Obstetrics and Gynaecology Clinic, Department of Biomedicine and Prevention, University of Roma "Tor Vergata", Roma, Italy
| | - Giulia Mattioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
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33
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Supermainam S, Koh ET. Laparoscopic Partial Bladder Cystectomy for Bladder Endometriosis: A Combined Cystoscopic and Laparoscopic approach. J Minim Invasive Gynecol 2020; 27:575-576. [DOI: 10.1016/j.jmig.2019.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
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34
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Widschwendter P, Janni W, Benckendorff J, de Gregorio N. Lethal haemorrhage due to erosion of external iliac artery in a patient with ureterovaginal fistula following endometriosis surgery. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519872868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case report of a patient with laparoscopic surgery of a deep infiltrating endometriosis with a complicative course. In addition to a postoperatively diagnosed ureteral fistula with local inflammation, acute perforation and ultimately lethal bleeding from the adjacent external iliac artery occurred more than 3 weeks after surgery. To the best of our knowledge, a case with the same constellation has not yet been published. A literature review on the rare and comparable complication of a ureteroarterial fistula is discussed in connection with the case.
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Affiliation(s)
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University, Ulm, Germany
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35
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An isolated bladder endometriosis misdiagnosed as a bladder tumor. Urol Case Rep 2019; 28:101062. [PMID: 31763170 PMCID: PMC6864348 DOI: 10.1016/j.eucr.2019.101062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022] Open
Abstract
Urinary bladder endometriosis as a part of deep infiltrating pelvic endometriosis is well known, but isolated bladder involvement is very rare. A 36-year-old woman, who had two cesarean sections, was complaining of dysuria, frequency and burning micturition. MRI showed a tissular mass probably originating from the cervix and suggestive of a sarcoma. Cystoscopy identified a nodular bluish retro trigonal mass, which was completely resected. Histopathological examination was consistent with a bladder endometrioma. The patient had a conservative treatment based on estrogen-progesterone combination. After three months' follow-up, ultrasound and cystoscopy were performed showing no signs of recurrence.
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36
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Unilateral Ureteric Endometriosis at the Pelvic Brim Resulting in Complete Loss of Renal Function. Case Rep Obstet Gynecol 2019; 2019:9194615. [PMID: 31737388 PMCID: PMC6815552 DOI: 10.1155/2019/9194615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/19/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022] Open
Abstract
Deep infiltrating endometriosis of the urinary tract is rare but can result in ureteric obstruction, hydroureteronephrosis and renal failure. Ureteric endometriosis usually affects the distal third of the left ureter among women of reproductive age. Greater awareness of ureteric endometriosis and a multidisciplinary approach in the management is essential to achieve optimal outcomes. We present an atypical case of right ureteric obstruction due to endometriosis at the pelvic brim resulting in complete loss of renal function and necessitating nephroureterectomy.
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37
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Hu Z, Li P, Liu Q, Zhu H, Sun Y, Zhao X, Xie L, Liu K. Ureteral endometriosis in patients with deep infiltrating endometriosis: characteristics and management from a single-center retrospective study. Arch Gynecol Obstet 2019; 300:967-973. [DOI: 10.1007/s00404-019-05268-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
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38
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Goggins ER, Wong M, Lindsey A, Einarsson JI, Cohen SL. Ureteroureteral anastomosis for endometriosis involving the ureter: Case series and literature review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519845993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The purpose of this study was to review operative management of endometriosis involving the ureter. Materials and methods: Retrospective case series of three patients undergoing resection of ureteral endometriosis with ureteroureterostomy for endometriosis involving the ureter by minimally invasive gynecologic surgeons between 2007 and 2018 at a large academic medical center in the Northeastern United States. A literature review was conducted to find cases with a similar approach. Results: Three cases of ureteral endometriosis surgically managed at our institution with ureteroureteral anastomosis were identified. Ureteral endometriosis was identified preoperatively by hydroureteronephrosis on imaging. Intrinsic ureteral endometriosis was confirmed by pathology in two cases; extrinsic endometriosis was grossly visualized in one case. Operative times ranged from 300 to 387 min. Estimated blood loss ranged from 150 to 250 mL. There were no intraoperative complications. A total of 151 cases with a similar approach were described in the literature. Recurrence of obstructive uropathy occurred in 11 cases. Conclusion: Ureteral endometriosis is a rare complication with several management options. Ureterectomy with ureteroureterostomy has been described in the literature and in three cases at our institution with low complication rates and rare stricture formation. This technique can be successful in the management of ureteral endometriosis and warrants further investigation.
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Affiliation(s)
| | - Marron Wong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexis Lindsey
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA
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39
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Retroperitoneal Endometrioid Carcinoma Arising from Ureteral Endometriosis. Case Rep Obstet Gynecol 2019; 2019:9273858. [PMID: 31281695 PMCID: PMC6590549 DOI: 10.1155/2019/9273858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2019] [Indexed: 01/27/2023] Open
Abstract
Primary ureteral endometriosis is considered to be an uncommon form with an incidence of less than 0.1% in endometriosis. We reported a case of retroperitoneal endometrioid carcinoma possibly arising from ureteral endometriosis. A 52-year-old woman complained left backache. A solid mass in left retroperitoneal cavity with hydronephrosis was found. Diagnostic laparotomy with bilateral salpingo-oophorectomy and biopsy of the mass were performed. Although the primary lesion was not defined in the surgery, the histopathological diagnosis of specimen was endometrioid carcinoma. In the interval debulking surgery after the chemotherapy, tumor adjacent the left iliac vessels was observed. We resected the mass together with 5 cm left ureter and performed ureterectomy and anastomosis. The patient was diagnosed as the malignant transformation of ureteral endometriosis. Adjuvant chemotherapy is now undergoing. In case of finding the cancer tissue in women, we should take into account the malignant transformation of less common endometriosis, including ureteral endometriosis.
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40
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Videourology Abstracts. J Endourol 2019; 33:505-508. [DOI: 10.1089/end.2019.29059.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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41
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Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, Ferrero S. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2019; 24:710-730. [PMID: 30165449 DOI: 10.1093/humupd/dmy027] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The ureter is the second most common site affected by urinary tract endometriosis, after the bladder. Optimal strategies in the diagnosis and treatment of ureteral endometriosis (UE) are not yet well defined. OBJECTIVE AND RATIONALE The aim of this study was to systematically review evidence regarding the epidemiology, pathophysiology, diagnosis, medical and surgical treatment, impact on fertility and risk of malignant transformation of UE. SEARCH METHODS A systematic literature review, by searching the MEDLINE and PUBMED database until April 2018, was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/PROSPERO CRD42017060065). A total of 67 articles were selected to be included in this review. OUTCOMES The involvement of the ureter by endometriosis is often asymptomatic or leads to non-specific symptoms. When the diagnosis is delayed, UE may lead to persistent hydronephrosis and eventually loss of renal function. Ultrasonography is the first-line technique for the assessment of UE; alternatively, magnetic resonance imaging provides an evaluation of ureteral type involvement. The surgical treatment of UE aims to relieve ureteral obstruction and avoid disease recurrence. It includes conservative ureterolysis or radical approaches, such as ureterectomy with end-to-end anastomosis or ureteroneocystostomy performed in relation to the type of ureteral involvement. Fertility and pregnancy outcomes are in line with those observed after surgical treatment of deep infiltrating endometriosis (DIE). Current evidence does not support the potential risk of malignant transformation of UE. WIDER IMPLICATIONS In this article, we review available evidence on ureteral endometriosis, providing a useful tool to guide physicians in the management of this disease. Diagnosis and management of UE remain a challenge. In relation to the degree of ureteral involvement and the association with other DIE implants, the surgical approach should be planned and carried out in an interdisciplinary collaboration between gynecologist and urologist.
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Affiliation(s)
- Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| | - Carolina Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| | - Ennio Biscaldi
- Department of Radiology, Galliera Hospital, Genova, Italy
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic Sciences, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, 'Sacro Cuore - Don Calabria' Hospital, Negrar, Verona, Italy
| | - Carlo Terrone
- Department of Urology, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
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42
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Kızılay F, Şimşir A, Nazlı O. Management of ureteral endometriosis and review of the literature. Turk J Urol 2018; 45:S166-S169. [PMID: 33120006 DOI: 10.5152/tud.2018.21605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/30/2018] [Indexed: 11/22/2022]
Abstract
Endometriosis can affect 10-15% of the women in their reproductive age and it is characterized with the presence of the functional endometrium tissue outside the uterine cavity. Up to 10% of the cases with urinary system endometriosis may involve the ureter. Left distal ureter is the most common site of involvement. The differentiation between intrinsic and extrinsic endometriosis is very substantial for the selection and application of definitive treatment. Medical and surgical treatment alternatives are available for endometriosis management and histopathologic examination is required for definitive diagnosis. In this case report, a 33-year-old patient underwent segmental ureter excision and ureteroureteral anastomosis due to endometriosis causing obstruction in the left distal ureter. The operation was performed through a left Gibson incision and a 6 Fr double J stent was implanted in the ureter. The stent was removed after 4 weeks and the control magnetic resonance imaging-urography was performed at 3 months postoperatively. Obstruction and hydroureteronephrosis were observed to be completely regressed in control. If there is no other obvious etiology for the presence of unilateral hydroureteronephrosis in women in their reproductive age, the diagnosis of endometriosis should be considered.
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Affiliation(s)
- Fuat Kızılay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Adnan Şimşir
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Oktay Nazlı
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
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43
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Habiba M, Brosens I, Benagiano G. Müllerianosis, Endocervicosis, and Endosalpingiosis of the Urinary Tract: A Literature Review. Reprod Sci 2018; 25:1607-1618. [PMID: 29739266 DOI: 10.1177/1933719118773441] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We reviewed reported cases of endocervicosis, endosalpingiosis, and müllerianosis of the bladder or ureters in women in order to highlight these conditions as distinct from endometriosis or adenomyosis. METHODS Medline and Scopus searches of all cases published till the October 1, 2017. All retrieved references were searched manually to identify relevant articles. RESULTS Twenty-six articles reported endocervicosis. These included 37 cases described by the authors as endocervicosis of the bladder. We identified 7 case reports of bladder endosalpingiosis. There were 26 publications including 27 cases of müllerianosis of the bladder and 3 cases affecting the lower ureter. Literature descriptions are limited but available accounts do not point to features that uniquely distinguished these conditions. Affected women tended to be older, and in many cases, there was a possible relation to past surgery and particularly to hysterectomy and caesarean sections. Many cases were reported in postmenopausal women. Local excision was sufficient in most cases. CONCLUSION The etiology of these conditions remains speculative, but case reports raise a possible link to pelvic surgery. There is a need for more detailed accounts of these lesions, which should be considered in the differential diagnosis of pre- and postmenopausal women with pelvic pain, dyspareunia, lower abdominal pain or discomfort, dysuria, frequency, or hematuria.
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Affiliation(s)
- Marwan Habiba
- 1 Department of Health Sciences, University of Leicester, Women and Perinatal Services, University Hospitals of Leicester, Leicester, United Kingdom
| | - Ivo Brosens
- 2 Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Giuseppe Benagiano
- 3 Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
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Bolze PA, Paparel P, Golfier F. [Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29526792 DOI: 10.1016/j.gofs.2018.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Urinary tract involvement by endometriosis is reported in 1% of endometriosis patients (NP3). Consequences range from pelvic pain for bladder localizations to silent kidney loss in case of chronic ureteral obstruction (NP3). The feasibility of laparoscopic management was widely proven (NP3) and may reduce hospital stay length (NP4). Radical surgery with partial cystectomy for bladder localizations was shown to significantly and durably reduce pain symptoms with low risk of a severe postoperative complications (NP3). Medical hormonal treatment also shows short-term reduction of pain symptoms (NP4). Transureteral resection of bladder endometriosis nodule is not recommended (grade C) because of a high postoperative recurrence rate (NP4). Given a high risk of silent kidney loss, it is recommended that patients with ureteral involvement by endometriosis are managed by a multidisciplinary team considering urinary and potential extra-urinary localizations of endometriosis (grade C). No recommendation can be made on which technique to prefer between conservative (ureterolysis) or radical surgical techniques or on benefit and length of ureteral stents in case of ureteral involvement. Surgical management of bladder and ureteral localizations of endometriosis do not seem to be associated with altered or improved postoperative fertility (NP4). Since late postoperative ureteral anastomosis stenosis were reported with silent kidney loss, repeated postoperative imaging monitoring is justified (expert opinion).
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Affiliation(s)
- P-A Bolze
- Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie gynécologique et oncologique - obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - P Paparel
- Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie urologique, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite
| | - F Golfier
- Université Claude-Bernard Lyon 1, hôpitaux universitaires de Lyon, centre hospitalier Lyon-Sud, service de chirurgie gynécologique et oncologique - obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Ota Y, Andou M, Ota I. Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis. Asian J Endosc Surg 2018; 11:7-14. [PMID: 29444547 DOI: 10.1111/ases.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/10/2018] [Indexed: 01/11/2023]
Abstract
Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.
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Affiliation(s)
| | | | - Ikuko Ota
- Kurashiki Heisei Hospital, Kurashiki, Japan
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Young S, Burns MK, DiFrancesco L, Nezhat A, Nezhat C. Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis. J Turk Ger Gynecol Assoc 2017; 18:200-209. [PMID: 29278234 PMCID: PMC5776160 DOI: 10.4274/jtgga.2017.0143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/03/2017] [Indexed: 01/28/2023] Open
Abstract
Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.
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Affiliation(s)
- Stacy Young
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
| | - Megan Kennedy Burns
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
| | - Lucia DiFrancesco
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
| | - Azadeh Nezhat
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
- University of California, San Francisco, School of Medicine, San Francisco, USA
| | - Camran Nezhat
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
- University of California, San Francisco, School of Medicine, San Francisco, USA
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Bendifallah S, Ballester M, Darai E. Prise en charge chirurgicale des lésions d’endométriose profondes avec atteinte digestive et urinaire. Presse Med 2017; 46:1212-1217. [DOI: 10.1016/j.lpm.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022] Open
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Huang JZ, Guo HL, Li JB, Chen SQ. Management of ureteral endometriosis with hydronephrosis: Experience from a tertiary medical center. J Obstet Gynaecol Res 2017; 43:1555-1562. [PMID: 28707816 DOI: 10.1111/jog.13422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jing-Zhi Huang
- Department of Gynecology and Obstetrics; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Hong-Ling Guo
- Department of Gynecology and Obstetrics; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Jin-Bo Li
- Department of Gynecology and Obstetrics; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Shu-Qin Chen
- Department of Gynecology and Obstetrics; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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Freire MJ, Dinis PJ, Medeiros R, Sousa L, Águas F, Figueiredo A. Deep Infiltrating Endometriosis-Urinary Tract Involvement and Predictive Factors for Major Surgery. Urology 2017; 108:65-70. [PMID: 28694092 DOI: 10.1016/j.urology.2017.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate urinary tract involvement by deep infiltrating endometriosis as well as the surgical treatment and existence of predictive factors for major urologic surgery. METHODS We conducted a retrospective analysis of 656 women submitted to surgery for endometriosis, of which 28 patients underwent minor or major surgery for deep infiltrating endometriosis involving the urinary tract, with a mean age of 38 ± 6.9 years (27-50) at diagnosis. Clinical data, surgeries performed, and complications were analyzed. Minor surgery was defined by endoscopic surgery or insertion of a percutaneous nephrostomy catheter, and major surgery included open or laparoscopic procedures. RESULTS Endometriomas affected the ureter in 13 (46.4%), the bladder in 11 (39.3%), and both structures in 4 (14.3%) patients. Twelve (42.9%) patients had decreased renal function, and ureteral involvement was predictive of renal function loss (P = .034). Minor surgeries were performed in most women with isolated bladder involvement and in 12 (42.9%) patients with ureteral infiltration. Patients with ureteric involvement underwent major surgeries more often (n = 12 vs n = 3; P = .025) and had longer hospitalization (8.2 vs 3.1 days, P = .05). After a mean follow-up of 36.3 (1-102) months, there was no bladder involvement recurrence. The most common complication was ureteral stenosis (Clavien-Dindo grade IIIb) in 3 (10.7%) patients. CONCLUSION Surgery is highly successful in most cases. Patients with ureteric involvement are more likely to lose kidney function, undergo major surgery, and have longer hospitalization.
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Affiliation(s)
- Maria José Freire
- Department of Urology and Renal Transplantation, Coimbra Hospital and University Centre, Portugal.
| | - Paulo Jorge Dinis
- Department of Urology and Renal Transplantation, Coimbra Hospital and University Centre, Portugal
| | - Rita Medeiros
- Department of Gynaecology A, Coimbra Hospital and University Centre, Portugal
| | - Luís Sousa
- Department of Urology and Renal Transplantation, Coimbra Hospital and University Centre, Portugal
| | - Fernanda Águas
- Department of Gynaecology A, Coimbra Hospital and University Centre, Portugal
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra Hospital and University Centre, Portugal; Faculty of Medicine, University of Coimbra, Portugal
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[Morbidity and functional long-term follow-up of patients with surgical treatment of urinary tract endometriosis]. ACTA ACUST UNITED AC 2017; 45:327-334. [PMID: 28552755 DOI: 10.1016/j.gofs.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/02/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess postoperative complications, improvement of pain symptoms and residual urinary functional symptoms after surgery for deep infiltrative endometriosis affecting ureter or bladder. METHODS Retrospective study of complications (Clavien-Dindo classification), pain (visual analog scale [VAS]) and urinary functional symptoms (Urinary Symptom Profile questionnaire [USP]) of patients surgically treated between 2007 and 2015 in University Hospitals of Lyon. RESULTS Among 31 patients with endometriosis involving the bladder, 83.9% had a partial cystectomy and 16.1% an extra-mucosal resection. Among patients (n=20) with ureteral involvement, 85% had ureterectomy with ureterocystoneostomy and 15% had only ureterolysis. Grade III postoperative complications occurred in 6% and 0% of patients with bladder or ureteral surgery, respectively and no grade IV or V complications were reported. Mean bladder VAS dropped from 5.3±4.2 to 0.3±0.9 after a follow-up of 42 months (P<0.0001). In patients with ureteral involvement, mean flank VAS dropped from 3.6 to 0.9 after a follow-up of 33 months (P<0.0005). Mean postoperative USP score for dysuria and detrusor overactivity were 1.35/9 and 2.48/21 in case of bladder involvement, and 1.10/9 and 2.15/21 in case of ureteral involvement. CONCLUSION Multidisciplinary surgical management of deep infiltrative endometriosis affecting urinary tract was associated to a low risk of severe postoperative complications and to a long-term significant improvement of pain symptoms without significant residual functional urinary symptoms.
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