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Piriyev E, Römer T. Diaphragm endometriosis: Random localization or extended form of pelvis endometriosis. A large comparative analysis of 202 cases. Eur J Obstet Gynecol Reprod Biol 2024; 294:117-122. [PMID: 38237309 DOI: 10.1016/j.ejogrb.2024.01.020] [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: 12/19/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE The aim of this study was to investigate and present the clinical characteristics of diaphragm endometriosis, to approach the pathogenetic mechanisms, and to answer the question of whether this disease can be considered an extended form of pelvic endometriosis. STUDY DESIGN It was a retrospective comparative one-to-one analysis of 202 cases. Two groups of patients were compared: Group 1 patients with diaphragm endometriosis vs Group 2 (control group) with pelvis endometriosis, each with 101 patients. RESULTS Patients with diaphragm endometriosis had extreme significantly higher prevalence of severe pelvis endometriosis included deep infiltrated endometriosis and severe adhesions in term of complete Douglas obliteration (p value = 0.0001). There was neither age nor BMI difference in two groups. Besides of cyclic shoulder or upper abdomen pain there was no difference of symptoms. CONCLUSION Diaphragm endometriosis is a rare condition with an approximate prevalence of 1.1% of all endometriosis cases. Since the symptoms are very specific and patients do not associate the pain with diaphragmatic endometriosis, the symptoms should be asked about explicitly. If patients with diaphragmatic endometriosis have no symptoms, the lesions do not necessarily need to be removed. The pathogenesis is still unclear. The authors of this study consider this disease to be an extended form of severe pelvic and deep infiltrated endometriosis. However, the right-side dominance still cannot be explained. Further research is needed to fully understand the origin of diaphragmatic endometriosis.
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Affiliation(s)
- Elvin Piriyev
- University Witten-Herdecke, Germany; Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal, Germany.
| | - Thomas Römer
- University of Cologne, Germany; Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal, Germany
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Robbins SJ, Brown SE, Stennett CA, Tuddenham S, Johnston ED, Wnorowski AM, Ravel J, He X, Mark KS, Brotman RM. Uterine fibroids and longitudinal profiles of the vaginal microbiota in a cohort presenting for transvaginal ultrasound. PLoS One 2024; 19:e0296346. [PMID: 38315688 PMCID: PMC10843103 DOI: 10.1371/journal.pone.0296346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024] Open
Abstract
Bacterial vaginosis, characterized in part by low levels of vaginal Lactobacillus species, has been associated with pro-inflammatory cytokines which could fuel uterine fibroid development. However, prior work on the associations between uterine fibroids and vaginal bacteria is sparse. Most studies have focused on assessment of individual taxa in a single sample. To address research gaps, we sought to compare short, longitudinal profiles of the vaginal microbiota in uterine fibroid cases versus controls with assessment for hormonal contraceptives (HCs), a possible confounder associated with both protection from fibroid development and increases in Lactobacillus-dominated vaginal microbiota. This is a secondary analysis of 83 reproductive-age cisgender women who presented for transvaginal ultrasound (TVUS) and self-collected mid-vaginal swabs daily for 1-2 weeks before TVUS (Range: 5-16 days, n = 697 samples). Sonography reports detailed uterine fibroid characteristics (N = 21 cases). Vaginal microbiota was assessed by 16S rRNA gene amplicon sequencing and longitudinal microbiota profiles were categorized by hierarchical clustering. We compared longitudinal profiles of the vaginal microbiota among fibroid cases and controls with exact logistic regression. Common indications for TVUS included pelvic mass (34%) and pelvic pain (39%). Fibroid cases tended to be older and report Black race. Cases less often reported HCs versus controls (32% vs. 58%). A larger proportion of cases had low-Lactobacillus longitudinal profiles (48%) than controls (34%). In unadjusted analysis, L. iners-dominated and low-Lactobacillus profiles had higher odds of fibroid case status compared to other Lactobacillus-dominated profiles, however these results were not statistically significant. No association between vaginal microbiota and fibroids was observed after adjusting for race, HC and menstruation. Results were consistent when number of fibroids were considered. There was not a statistically significant association between longitudinal profiles of vaginal microbiota and uterine fibroids after adjustment for common confounders; however, the study was limited by small sample size.
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Affiliation(s)
- Sarah J. Robbins
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sarah E. Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Christina A. Stennett
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Susan Tuddenham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Elizabeth D. Johnston
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amelia M. Wnorowski
- Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Xin He
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland, United States of America
| | - Katrina S. Mark
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Rebecca M. Brotman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
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Nezhat C, Khoyloo F, Tsuei A, Armani E, Page B, Rduch T, Nezhat C. The Prevalence of Endometriosis in Patients with Unexplained Infertility. J Clin Med 2024; 13:444. [PMID: 38256580 DOI: 10.3390/jcm13020444] [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: 12/12/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.
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Affiliation(s)
- Camran Nezhat
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco, San Francisco, CA 94143, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Farrah Khoyloo
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Angie Tsuei
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Ellie Armani
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Barbara Page
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Thomas Rduch
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), CH-9014 St. Gallen, Switzerland
- Department of Gynecology and Obstetrics, Cantonal Hospital St. Gallen (KSSG), CH-9007 St. Gallen, Switzerland
| | - Ceana Nezhat
- Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA 30342, USA
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Abu-Zaid A, Gari A, Tulbah M, Alshahrani MS, Khadawardi K, Ahmed AM, Baradwan A, Bukhari IA, Alyousef A, Alomar O, Abuzaid M, Baradwan S. Association between endometriosis and obstetric complications: Insight from the National Inpatient Sample. Eur J Obstet Gynecol Reprod Biol 2024; 292:58-62. [PMID: 37976766 DOI: 10.1016/j.ejogrb.2023.11.009] [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: 06/18/2023] [Revised: 09/11/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database. METHODS The ICD-10 coding system was used to identify codes for endometriosis and obstetric outcomes, and data from the NIS (2016-2019) were analyzed. Descriptive statistics were used to summarize variables, while the chi-square test was used to detect significant differences for categorical variables. Univariate and multivariate regression analyses were conducted to assess the association between endometriosis and obstetric outcomes. On multivariate analysis, adjustment was done for age, race, hospital region, smoking status, and alcohol misuse. Forest plots were used to visualize odds ratios and their 95% confidence intervals. RESULTS Overall, 2,854,149 women were included in this analysis, of whom 4,006 women had endometriosis. The post-hoc Bonferroni correction was applied to account for multiple comparisons, and our analyses revealed several statistically significant associations (p < 0.004). Specifically, on univariate analysis, significant associations with endometriosis were identified for ruptured uterus, placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, gestational diabetes, preterm labor, and multiple gestation. On multivariate analysis, significant associations with endometriosis were observed for placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, preterm labor, premature rupture of membranes, and multiple gestation. CONCLUSION The present findings provide important insights into the potential relationship between endometriosis and various adverse obstetric outcomes and may help inform clinical practice and future research. Further studies that use more detailed clinical data and longitudinal designs are needed to solidify the presented conclusions.
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Affiliation(s)
- Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Abdulrahim Gari
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; Department of Obstetrics and Gynecology, Almurjan Hospital, Jeddah, Saudi Arabia
| | - Maha Tulbah
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Albagir Mahdi Ahmed
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Afnan Baradwan
- Department of Obstetrics and Gynecology, Almurjan Hospital, Jeddah, Saudi Arabia
| | - Ibtihal Abdulaziz Bukhari
- Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdullah Alyousef
- Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, Muhayil General Hospital, Muhayil, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Moiño D, Sarkar P, Al Jumaily M, Malak S, Tanner JP, Mikhail E. Association between pathological positivity rate of endometriosis, demographics, and concomitant gynecological conditions. Ther Adv Reprod Health 2024; 18:26334941241242351. [PMID: 38618559 PMCID: PMC11015736 DOI: 10.1177/26334941241242351] [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: 09/04/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Background To date, there remains a paucity of present-day literature on the topic of demographics and the biopsy-proven pathological positivity rate of endometriosis. Objective The goal of this study was to explore the association between patients' demographics and other concomitant gynecological conditions or procedures and the pathological positivity rate of excision of endometriosis. Design Retrospective cohort study. Methods All women >18 years old who underwent laparoscopic surgery for endometriosis at a tertiary care hospital from October 2011 to October 2020. Women were classified into two groups: (1) Study group: women with >80% pathological positivity rate of endometriosis and (2) Control group: women with <80% pathological positivity rate. Results A total of 401 women were included in the analysis. No difference was noted in the 80% pathological positivity rate based on body mass index [BMI; 68.7% in normal BMI versus 80% in underweight, versus 74.5% in overweight, and 74.1% in obese patients (p = 0.72)]. The percentage of patients reaching 80% pathological positivity of endometriosis was lower in women who had undergone previous laparoscopy for endometriosis compared to surgery naïve women (66.5% versus 76.5%, p = 0.03). In addition, a higher percentage of women who underwent concomitant hysterectomy (83.5% versus 68.8% for non-hysterectomy, p = 0.005) or bilateral oophorectomy (92.7% versus 70.0% for non-oophorectomy, p = 0.002) reached 80% pathological positivity. Women with an associated diagnosis of fibroids (79.7% versus 70.5%) or adenomyosis (76.4% versus 71.7%) were more likely to reach 80% pathological positivity compared to women without any other coexisting pathology; however, the observed differences were not statistically significant. After applying a log-binomial regression model, compared to White non-Hispanics, Hispanic patients were 30% less likely to reach 80% positivity (RR: 0.70, 95% CI: 0.49-1.02), although not statistically significant. Conclusion No significant racial difference was found when comparing the rates of 80% pathological positivity of suspected endometriosis lesions among groups. Endometriosis pathological positivity rate was unaffected by patients' BMI and the presence of concomitant pathologies. In addition, prior laparoscopic surgery for endometriosis might cause tissue changes that result in a decrease in the observed pathological positivity rate of endometriosis lesions during subsequent surgeries.
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Affiliation(s)
- Daniela Moiño
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Papri Sarkar
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Maha Al Jumaily
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | | | - Jean Paul Tanner
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Emad Mikhail
- Division of Gynecologic Subspecialities, Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL 33606, USA
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Nezhat C, Armani E, Chen HCC, Najmi Z, Lindheim SR, Nezhat C. Use of the Free Endometriosis Risk Advisor App as a Non-Invasive Screening Test for Endometriosis in Patients with Chronic Pelvic Pain and/or Unexplained Infertility. J Clin Med 2023; 12:5234. [PMID: 37629276 PMCID: PMC10455338 DOI: 10.3390/jcm12165234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Endometriosis is a prevalent condition that affects millions of individuals globally, leading to various symptoms and significant disruptions to their quality of life. However, the diagnosis of endometriosis often encounters delays, emphasizing the pressing need for non-invasive screening. This retrospective cross-sectional study aimed to evaluate the utility of the Endometriosis Risk Advisor (EndoRA) mobile application in screening for endometriosis in patients with chronic pelvic pain and/or unexplained infertility. The study consisted of 293 patients who met specific criteria: they were English-speaking individuals with chronic pelvic pain and/or unexplained infertility, owned smartphones, and had no prior diagnosis of endometriosis. The results demonstrated that the EndoRA score exhibited a high sensitivity of 93.1% but a low specificity of 5.9% in detecting endometriosis. The positive predictive value was 94.1%, while the negative predictive value was 5.0%. Although the study had limitations and potential selection bias, its findings suggest that EndoRA can serve as a valuable screening tool for high-risk individuals, enabling them to identify themselves as being at an increased risk for endometriosis. EndoRA's non-invasive nature, free access, and easy accessibility have the potential to streamline evaluation and treatment processes, thereby empowering individuals to seek timely care and ultimately improving patient outcomes and overall well-being.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Ellie Armani
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Hsuan-Chih Carolina Chen
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- Stanford University Medical Center, Palo Alto, CA 94305, USA
| | - Zahra Najmi
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Steven R. Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45324, USA
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, USA
- Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ceana Nezhat
- Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA 30342, USA
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Nezhat C, Zaghi B, Baek K, Nezhat A, Nezhat F, Lindheim S, Nezhat C. Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study. J Clin Med 2023; 12:jcm12113720. [PMID: 37297915 DOI: 10.3390/jcm12113720] [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: 03/10/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Cesarean scar defect, also known as niche, isthmocele, uteroperitoneal fistula and uterine diverticulum, is a known complication after cesarean delivery. Due to the rising cesarean delivery rates, niche has become more common and can present as irregular bleeding, pelvic pain, infertility, cesarean scar pregnancy and uterine rupture. Treatments for symptomatic cesarean scar defect vary and include hormonal therapy, hysteroscopic resection, vaginal or laparoscopic repair, and hysterectomy. We report on the safety and efficacy of our method of repairing cesarean scar defects in 27 patients without adverse outcomes: two-layer repair where the suture does not enter the uterine cavity. Our method of laparoscopic niche repair improves symptoms in nearly 77% of patients, restores fertility in 73% of patients, and decreases the time to conception.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Palo Alto, CA 94061, USA
- Stanford University Medical Center, Stanford, CA 94305, USA
- University of California, San Francisco, CA 94143, USA
| | | | - Kelly Baek
- California Fertility Partners, Los Angeles, CA 90025, USA
| | - Azadeh Nezhat
- Camran Nezhat Institute, Palo Alto, CA 94061, USA
- Stanford University Medical Center, Stanford, CA 94305, USA
- University of California, San Francisco, CA 94143, USA
| | - Farr Nezhat
- Nezhat Surgery for Gynecology/Oncology, New York, NY 10128, USA
- Department of Obstetrics and Gynecology, NYU Hospital, NYU Long Island School of Medicine, Mineola, NY 10016, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Steven Lindheim
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, USA
- Boonshoft School of Medicine, Wright State University, Dayton, OH 45324, USA
| | - Ceana Nezhat
- Nezhat Medical Center, Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA 30342, USA
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Applebaum JC, Kim EK, Rush M, Shah DK. Safety of Same-Day Discharge Versus Hospital Admission in Minimally Invasive Myomectomy. J Minim Invasive Gynecol 2023; 30:382-388. [PMID: 36708763 DOI: 10.1016/j.jmig.2023.01.007] [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: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE To compare postoperative complication rates between same-day discharge patients and patients admitted to hospital after minimally invasive myomectomy, stratified by patient demographics and perioperative variables including myoma burden. DESIGN Retrospective cohort study. Setting Hospitals participating in the National Surgical Quality Improvement Program database from January 2015 to December 2019. PATIENTS Female patients aged ≥18 years undergoing minimally invasive myomectomy. INTERVENTIONS Patients were categorized into either the same-day discharge or admitted patient cohort. Univariate comparisons of demographics, perioperative variables, and 30-day postoperative complications were performed. Multivariate logistic regression was used to 1) identify demographic and perioperative factors associated with admission, and 2) compare postoperative complication rates of same-day discharge patients with those of admitted patients while adjusting for demographic and perioperative factors. MEASUREMENTS AND MAIN RESULTS Eight thousand one hundred patients were recruited during the study period. The overall rate of same-day discharge was 57.2% in 2015 and 65.0% in 2019. The same-day discharge rate was 64.6% for patients with a smaller myoma burden (1-4 fibroids and ≤250 grams, Current Procedural Terminology 58545) and 56.8% for larger myoma burden (≥5 fibroids or >250 grams, Current Procedural Terminology 58546). Age, race, American Society of Anesthesiologists classification III or IV, preoperative hematocrit <36%, hypertension, diabetes, bleeding disorder, and increasing operative time were associated with admission to hospital. After adjusting for these variables, composite postoperative complication rates were similar between admitted patients and patients who were discharged the same day regardless of myoma burden (adjusted OR [aOR], 0.66; 95% confidence interval [CI] 0.18-2.47 for low myoma burden and aOR, 0.91; 95% CI 0.18-4.63 for high myoma burden). Admitted patients with both low (aOR, 9.1; 95% CI 2.27-37.04) and high (aOR, 8.24; 95% CI 1.59-42.49) myoma burdens were significantly more likely to receive a blood transfusion compared to same-day discharge patients. CONCLUSION Same-day discharge after minimally invasive myomectomy, regardless of myoma burden, is associated with low complication rates. Our findings may aid in shared decision making on discharge planning.
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Affiliation(s)
- Jeremy C Applebaum
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Drs. Applebaum and Rush), Philadelphia, Pennsylvania.
| | - Edward K Kim
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Dr. Kim), Philadelphia, Pennsylvania
| | - Margaret Rush
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Drs. Applebaum and Rush), Philadelphia, Pennsylvania
| | - Divya K Shah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania (Dr. Shah), Philadelphia, Pennsylvania
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Al Shukri M, Al Riyami AS, Al Ghafri W, Gowri V. Are There Predictors of Early Diagnosis of Endometriosis Based on Clinical Profile? A Retrospective Study. Oman Med J 2023; 38:e458. [PMID: 36873797 PMCID: PMC9975661 DOI: 10.5001/omj.2023.35] [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: 05/02/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Significant delays occur in referring cases for care of endometriosis, despite women suffering for years. This study was conducted to assess whether there is a specific symptom profile characteristic of endometriosis to alert physicians for earlier referrals. Methods In this retrospective observational cohort study, patient data of the women who attended Sultan Qaboos University Hospital from January 2011 to December 2019 with a diagnosis of endometriosis was collected from the hospital's electronic data archive and analyzed. Results Cases of N = 262 endometriosis patients were studied. The diagnosis was surgical in 198 (75.6%) of patients and the remaining 64 (24.4%) were diagnosed by clinical assessment and imaging. The mean age at diagnosis was 30.7±6.8 years (range = 15-51). The presence of ovarian endometrioma on ultrasound served as an alert for earlier referral. The mean age at diagnosis for those who had an endometrioma was 30.3±6.7 years and 32.4±7.1 years for those without an endometrioma without a significant difference. The mean age at diagnosis for those who did not have pain was 31.2 years and those with pain was 30.0 years (p =0.894; CI: -2.58-2.91). Among the 163 married women in the sample, 88 (54.0%) had primary infertility, and 31 (19.0%) had secondary infertility. There was no significant difference between the groups in the mean age at diagnosis (analysis of variance test; p =0.056). Over the nine-year period, diagnosis was made at progressively younger ages (p =0.047). Conclusions Based on this study, no specific symptom profile appears to predict an early diagnosis of endometriosis. However, over the years the diagnosis of endometriosis is made earlier likely due to increasing awareness of women and their physicians about the disease.
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Affiliation(s)
- Maryam Al Shukri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Al Shaima Al Riyami
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Wadha Al Ghafri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Vaidyanathan Gowri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
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Nezhat C, Agarwal S, Lee DA, Tavallaee M. Can we accurately diagnose endometriosis without a diagnostic laparoscopy? J Turk Ger Gynecol Assoc 2022; 23:117-119. [PMID: 35642436 PMCID: PMC9161000 DOI: 10.4274/jtgga.galenos.2022.2022-2-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Mba SG, Omeke CA, Enebe JT, Anyanwu OC. Primary umbilical endometriosis coexisiting with multiple uterine fibroids: A case report. Int J Surg Case Rep 2022; 94:107129. [PMID: 35658299 PMCID: PMC9079767 DOI: 10.1016/j.ijscr.2022.107129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- S G Mba
- Department of Obstetrics & Gynaeoclogy, Enugu State University of Science and Technology, College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria
| | - C A Omeke
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria.
| | - J T Enebe
- Department of Obstetrics & Gynaeoclogy, Enugu State University of Science and Technology, College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria
| | - O C Anyanwu
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria
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12
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Balogova S, Daraï E, Noskovicova L, Lukac L, Talbot JN, Montravers F. Interference of Known or Suspected Endometriosis in Reporting FDG PET/CT Performed in Another Indication. Clin Nucl Med 2022; 47:305-313. [PMID: 35119396 PMCID: PMC8884178 DOI: 10.1097/rlu.0000000000004049] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Endometriosis is a common gynecologic condition that may be visualized on 18F-FDG PET/CT and mimic lesions of malignancy. We analyzed the interference of known or suspected endometriosis in reporting 18F-FDG PET/CT performed in another indication. RESULTS The PET/CT images of 18 women with known (n = 15) or suspected (n = 3) endometriosis were analyzed. Based on clinical follow-up and results of other imaging, biopsy, and/or postsurgical histology, the presence of lesions of endometriosis at the time of 18F-FDG PET/CT was confirmed in 13 of 18 patients (72%). The per-patient positivity rate of 18F-FDG PET/CT was 8/18 (44%; 95% confidence interval, 22%-69%). The patient-based detection rate of 18F-FDG PET/CT in patients with confirmed lesions of endometriosis was 8/13 (62%; confidence interval, 32%-86%). On per-lesion/site basis, 18F-FDG PET/CT detected 11 of 20 sites (55%) of endometriosis. The SUVmax of these lesions/sites ranged between 1.8 and 5.3 (median, 3.8). In 9 of 18 patients (50%), a total of 13 non-endometriosis-related lesions/sites were detected by 18F-FDG PET/CT; their SUVmax ranged between 2.7 and 23 (median, 9.4). CONCLUSION The interference of known or suspected endometriosis in reporting 18F-FDG PET/CT performed in another indication was limited but possible and should be kept in mind, even in postmenopausal women, as the oldest patient with 18F-FDG-positive endometriosis was aged 63 years. The lesions of endometriosis showed inconstant 18F-FDG uptake with overlap of SUVmax with low-grade malignancies. In our series, the greatest SUVmax value of lesion of endometriosis was 5.3, somewhat higher than the threshold of 4 previously proposed for identification of malignant transformation of endometriosis.
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Affiliation(s)
- Sona Balogova
- From the Nuclear Medicine, GH Tenon-St Antoine and Sorbonne University, Assistance Publique des Hôpitaux de Paris, Paris, France
- Department of Nuclear medicine of Comenius University and St Elisabeth Oncology Institute, Bratislava, Slovakia
| | - Emile Daraï
- Department of Gynecology and Obstetrics, Tenon Hospital, Sorbonne University, Assistance Publique des Hôpitaux de Paris
- French National Cancer Associé à La Grossesse (CALG) Network, Sorbonne University, Assistance Publique des Hôpitaux de Paris Tenon
- INSERM U938, IUC-UPMC, Sorbonne University, Paris, France
| | - Lucia Noskovicova
- Department of Nuclear medicine of Comenius University and St Elisabeth Oncology Institute, Bratislava, Slovakia
| | - Ludovit Lukac
- First Department of Internal Medicine of Comenius University and University Hospital of Bratislava, Bratislava, Slovakia
| | - Jean-Noël Talbot
- From the Nuclear Medicine, GH Tenon-St Antoine and Sorbonne University, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Françoise Montravers
- From the Nuclear Medicine, GH Tenon-St Antoine and Sorbonne University, Assistance Publique des Hôpitaux de Paris, Paris, France
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13
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Eburne L, Vagovic RJ. Successful Laparoscopic-Assisted Supracervical Hysterectomy in a 14-Week-Sized Fibroid Uterus: An Autobiographical Case Report. Cureus 2022; 14:e21543. [PMID: 35223316 PMCID: PMC8864580 DOI: 10.7759/cureus.21543] [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] [Accepted: 01/23/2022] [Indexed: 11/05/2022] Open
Abstract
Uterine leiomyomas are a very common gynecological condition. This case report describes the author’s experience pursuing definitive treatment of a 14-week-sized fibroid uterus, the associated menometrorrhagia, and bulk symptoms. Barriers still remain if women of reproductive age prefer ovary-sparing hysterectomy. Laparoscopic supracervical hysterectomy with contained morcellation remains a well-tolerated and low-risk option dependent on surgeon expertise and informed patient consent. Literature review reveals the psychosocial and financial burden of uterine leiomyomas may present multiple challenges, affecting the quality of life.
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14
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Nezhat C, Agarwal S. Bowel endometriosis. Fertil Steril 2021; 117:384-386. [DOI: 10.1016/j.fertnstert.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022]
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15
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Uimari O, Nazri H, Tapmeier T. Endometriosis and Uterine Fibroids (Leiomyomata): Comorbidity, Risks and Implications. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:750018. [PMID: 36304022 PMCID: PMC9580755 DOI: 10.3389/frph.2021.750018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Uterine Fibroids (leiomyomata) and endometriosis affect millions of women world-wide. Although aetiology and natural history of the conditions are markedly different, symptoms can overlap and make differential diagnoses necessary, often using invasive methods such as laparoscopy. Considerable comorbidity exists between the two conditions and needs to be taken into account when treating fibroids and/or endometriosis. The genetic foundations of both uterine fibroids and endometriosis remain to be fully understood but recent evidence suggest common underpinnings. Here, we discuss the comorbidity of uterine fibroids and endometriosis and the implications for diagnosis, treatment and risks.
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Affiliation(s)
- Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University, Oulu, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology) and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Hannah Nazri
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Thomas Tapmeier
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- *Correspondence: Thomas Tapmeier
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16
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Intramural myomas more than 3-4 centimeters should be surgically removed before in vitro fertilization. Fertil Steril 2021; 116:945-958. [PMID: 34579828 DOI: 10.1016/j.fertnstert.2021.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/29/2022]
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17
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Awonuga AO, Chatzicharalampous C, Thakur M, Rambhatla A, Qadri F, Awonuga M, Saed G, Diamond MP. Genetic and Epidemiological Similarities, and Differences Between Postoperative Intraperitoneal Adhesion Development and Other Benign Fibro-proliferative Disorders. Reprod Sci 2021; 29:3055-3077. [PMID: 34515982 DOI: 10.1007/s43032-021-00726-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/22/2021] [Indexed: 12/11/2022]
Abstract
Intraperitoneal adhesions complicate over half of abdominal-pelvic surgeries with immediate, short, and long-term sequelae of major healthcare concern. The pathogenesis of adhesion development is similar to the pathogenesis of wound healing in all tissues, which if unchecked result in production of fibrotic conditions. Given the similarities, we explore the published literature to highlight the similarities in the pathogenesis of intra-abdominal adhesion development (IPAD) and other fibrotic diseases such as keloids, endometriosis, uterine fibroids, bronchopulmonary dysplasia, and pulmonary, intraperitoneal, and retroperitoneal fibrosis. Following a literature search using PubMed database for all relevant English language articles up to November 2020, we reviewed relevant articles addressing the genetic and epidemiological similarities and differences in the pathogenesis and pathobiology of fibrotic diseases. We found genetic and epidemiological similarities and differences between the pathobiology of postoperative IPAD and other diseases that involve altered fibroblast-derived cells. We also found several genes and single nucleotide polymorphisms that are up- or downregulated and whose products directly or indirectly increase the propensity for postoperative adhesion development and other fibrotic diseases. An understanding of the similarities in pathophysiology of adhesion development and other fibrotic diseases contributes to a greater understanding of IPAD and these disease processes. At a very fundamental level, blocking changes in the expression or function of genes necessary for the transformation of normal to altered fibroblasts may curtail adhesion formation and other fibrotic disease since this is a prerequisite for their development. Similarly, applying measures to induce apoptosis of altered fibroblast may do the same; however, apoptosis should be at a desired level to simultaneously ameliorate development of fibrotic diseases while allowing for normal healing. Scientists may use such information to develop pharmacologic interventions for those most at risk for developing these fibrotic conditions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
| | - Charalampos Chatzicharalampous
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Mili Thakur
- Reproductive Genomics Program, The Fertility Center, Grand Rapids, MI, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Anupama Rambhatla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Farnoosh Qadri
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Modupe Awonuga
- Division of Neonatology, Department of Pediatrics and Human Development, Michigan State University, 1355 Bogue Street, East Lansing, MI, USA
| | - Ghassan Saed
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, 1120 15th Street, CJ-1036, Augusta, GA, 30912, USA
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18
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Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women. PLoS One 2021; 16:e0256772. [PMID: 34437644 PMCID: PMC8389431 DOI: 10.1371/journal.pone.0256772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/15/2021] [Indexed: 12/18/2022] Open
Abstract
Objective Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data. Design Data were sourced from Taiwan’s Longitudinal Health Insurance Database 2000 (LHID2000). Materials and methods We identified 31,239 women aged ≥20 years diagnosed with uterine leiomyoma (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 218) between Jan 1, 2000 and Dec 31, 2012, who were matched with 124,956 controls (1:4) by 5-year age groups and year of diagnosis. Follow-up was from the date of LHID2000 entry to the first occurrence of endometriosis, loss to follow-up, insurance termination, or until December 31, 2013, whichever was earlier. Results In Cox regression analysis, the adjusted hazard ratio (aHR) for endometriosis in women with uterine leiomyoma was 6.44 (95% CI, 6.18, 6.72) compared with controls. The risk of endometriosis was significantly increased in women with uterine leiomyoma and comorbidities of tube-ovarian infection (aHR 2.86; 95% CI, 1.28, 6.36), endometritis (1.14; 1.06, 1.24), infertility (1.26; 1.16, 1.37), or allergic diseases (1.11; 1.05, 1.17). Having both uterine leiomyoma and endometritis significantly increased the risk of endometriosis (aHR 6.73; 95% CI, 6.07, 7.45) versus having only uterine leiomyoma (6.61; 6.33, 6.91) or endometritis (1.49; 1.31, 1.69). Similarly, having both uterine leiomyoma and infertility significantly increased the risk of endometriosis (aHR 6.95; 95% CI, 6.21, 7.78) versus having only uterine leiomyoma (6.66; 6.38, 6.96) or infertility (1.78; 1.57, 2.02). Conclusions A diagnosis of uterine leiomyoma appears to increase the risk of endometriosis. Patients presenting with uterine fibroids should be encouraged to give informed consent for possible simultaneous surgical treatment of endometriosis.
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19
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Genomics of Endometriosis: From Genome Wide Association Studies to Exome Sequencing. Int J Mol Sci 2021; 22:ijms22147297. [PMID: 34298916 PMCID: PMC8304276 DOI: 10.3390/ijms22147297] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
This review aims at better understanding the genetics of endometriosis. Endometriosis is a frequent feminine disease, affecting up to 10% of women, and characterized by pain and infertility. In the most accepted hypothesis, endometriosis is caused by the implantation of uterine tissue at ectopic abdominal places, originating from retrograde menses. Despite the obvious genetic complexity of the disease, analysis of sibs has allowed heritability estimation of endometriosis at ~50%. From 2010, large Genome Wide Association Studies (GWAS), aimed at identifying the genes and loci underlying this genetic determinism. Some of these loci were confirmed in other populations and replication studies, some new loci were also found through meta-analyses using pooled samples. For two loci on chromosomes 1 (near CCD42) and chromosome 9 (near CDKN2A), functional explanations of the SNP (Single Nucleotide Polymorphism) effects have been more thoroughly studied. While a handful of chromosome regions and genes have clearly been identified and statistically demonstrated as at-risk for the disease, only a small part of the heritability is explained (missing heritability). Some attempts of exome sequencing started to identify additional genes from families or populations, but are still scarce. The solution may reside inside a combined effort: increasing the size of the GWAS designs, better categorize the clinical forms of the disease before analyzing genome-wide polymorphisms, and generalizing exome sequencing ventures. We try here to provide a vision of what we have and what we should obtain to completely elucidate the genetics of this complex disease.
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20
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Wu BJ, Wei W, Hu CY, Zhang XJ, Zhong F. Investigation on factors related to uterine fibroids in rural women of northern Anhui province. J Obstet Gynaecol Res 2021; 47:3279-3287. [PMID: 34212456 DOI: 10.1111/jog.14899] [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: 11/22/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
AIM Given the increasing prevalence of hysteromyoma among the Chinese rural women of childbearing age, it is imperative that more attention should be given to researching risk factors that predispose women to this condition so that early preventive measures may be taken. Our study investigates potential risk factors for uterine fibroids such as participants' demographic characteristics (age, ethnicity, education), physiological characteristics (age at menarche, primiparous age), and the occurrence of several different female reproductive diseases (vaginitis, pelvic inflammatory disease). METHODS 2200 rural women of reproductive age were screened from a cross-sectional study carried out in the northern Anhui province. Data were collected by questionnaire surveys, gynecological and laboratory examinations and were subjected to univariate and multivariate analysis to evaluate the risk factors for uterine fibroids. RESULTS Of the 2200 women, 440 had uterine fibroids. In general, women with endometriosis, ovarian cysts and early menarche were more likely to suffer from hysteromyoma. Factors including higher parity, late age of first childbirth, and a regular menstrual cycle were associated with the reduced risk of uterine fibroids. CONCLUSIONS Our findings indicate that parameters such as earlier age of menarche, early primiparous age, lower parity and a variety of female reproductive diseases were associated with an increased risk of uterine fibroids. These findings may be used to guide the formulation of effective prevention and intervention protocols to improve the reproductive health of rural women.
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Affiliation(s)
- Bing-Jie Wu
- Department of Oncology, Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Wu Wei
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, Hefei, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Fei Zhong
- Department of Oncology, Fuyang Hospital of Anhui Medical University, Fuyang, China.,Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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21
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Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397:839-852. [PMID: 33640070 DOI: 10.1016/s0140-6736(21)00389-5] [Citation(s) in RCA: 373] [Impact Index Per Article: 124.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022]
Abstract
Endometriosis is a common disease affecting 5-10% of women of reproductive age globally. However, despite its prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and delivery of effective therapy is prolonged. Identification and prompt treatment of endometriosis are essential and facilitated by accurate clinical diagnosis. Endometriosis is classically defined as a chronic, gynaecological disease characterised by endometrial-like tissue present outside of the uterus and is thought to arise by retrograde menstruation. However, this description is outdated and no longer reflects the true scope and manifestations of the disease. The clinical presentation is varied, the presence of pelvic lesions is heterogeneous, and the manifestations of the disease outside of the female reproductive tract remain poorly understood. Endometriosis is now considered a systemic disease rather than a disease predominantly affecting the pelvis. Endometriosis affects metabolism in liver and adipose tissue, leads to systemic inflammation, and alters gene expression in the brain that causes pain sensitisation and mood disorders. The full effect of the disease is not fully recognised and goes far beyond the pelvis. Recognition of the full scope of the disease will facilitate clinical diagnosis and allow for more comprehensive treatment than currently available. Progestins and low-dose oral contraceptives are unsuccessful in a third of symptomatic women globally, probably as a result of progesterone resistance. Oral gonadotropin-releasing hormone (GnRH) antagonists constitute an effective and tolerable therapeutic alternative when first-line medications do not work. The development of GnRH antagonists has resulted in oral drugs that have fewer side-effects than other therapies and has allowed for rapid movement between treatments to optimise and personalise endometriosis care. In this Review, we discuss the latest understanding of endometriosis as a systemic disease with multiple manifestations outside the parameters of classic gynaecological disease.
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Affiliation(s)
- Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
| | - Alexander M Kotlyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Valerie A Flores
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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22
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Nezhat C, Rambhatla A, Miranda-Silva C, Asiaii A, Nguyen K, Eyvazzadeh A, Tazuke S, Agarwal S, Jun S, Nezhat A, Roman RA. BCL-6 Overexpression as a Predictor for Endometriosis in Patients Undergoing In Vitro Fertilization. JSLS 2020; 24:e2020.00064. [PMID: 33414614 PMCID: PMC7757768 DOI: 10.4293/jsls.2020.00064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the positive predictive value (PPV) of endometrial BCL-6 overexpression as a noninvasive screening test endometriosis in patients undergoing in vitro fertilization (IVF). METHODS Retrospective cohort study at a university-affiliated private practice. Inclusion criteria were reproductive age females currently undergoing IVF with a diagnosis of unexplained infertility or unexplained recurrent pregnancy loss. Those with endometrial BCL-6 overexpression underwent laparoscopic surgery with an indication for treatment of suspected endometriosis. The primary outcome was the PPV of endometrial BCL-6 testing to surgically diagnose endometriosis. Statistical analysis was performed using SPSS v.25.0. RESULTS Seventy-five patients met inclusion criteria for our study. The PPV of BCL-6 testing for endometriosis was 96%. Of those patients without endometriosis, 100% had other inflammatory pelvic pathologies, which were diagnosed and treated at the time of laparoscopy. CONCLUSIONS Endometrial BCL-6 overexpression has a high PPV for diagnosing endometriosis and can help identify a patient population that may require surgical treatment before embryo transfer.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Anupama Rambhatla
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Catarina Miranda-Silva
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Atena Asiaii
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Kimsa Nguyen
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | | | - Salli Tazuke
- The Colorado Center for Reproductive Medicine - San Francisco. Menlo Park, CA
| | - Shruti Agarwal
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Sunny Jun
- The Colorado Center for Reproductive Medicine - San Francisco. Menlo Park, CA
| | - Azadeh Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Robert A Roman
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
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23
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Nezhat C, Nguyen K, Ackroyd E, Roman RA, Rambhatla A, Nezhat A, Asiaii A. Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology. Cureus 2020; 12:e9882. [PMID: 32963921 PMCID: PMC7500726 DOI: 10.7759/cureus.9882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/22/2020] [Indexed: 01/25/2023] Open
Abstract
Background Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is known for its benefits as a definitive treatment for severe endometriosis. Undiagnosed endometriosis is common in patients with symptomatic fibroids or chronic pelvic pain. There are minimal studies that outline the safety and feasibility of nerve-sparing modified radical hysterectomy for other complex pelvic pathology in addition to endometriosis. Objectives The aim of this study is to evaluate the incidence of hospital readmission, intraoperative and postoperative complications, and long-term pain relief after laparoscopic nerve-sparing modified radical hysterectomy for severe endometriosis and complex benign pelvic pathology. Study design We performed a retrospective observational study of patients who underwent laparoscopic nerve-sparing modified radical hysterectomy with and without robotic-assistance with a high-volume minimally invasive endoscopic surgeon between November 2017 and December 2019. Results A total of 112 patients met the inclusion criteria. There were no cases of vaginal cuff dehiscence, venous thromboembolism, genitourinary system injury, gastrointestinal tract injury, vessel injury, nerve injury, sepsis, or death. Three patients required postoperative hospital admission for the management of umbilical cellulitis, acute blood loss anemia, and possible Addison's crisis. Other postoperative complications included allergic reaction to adhesives (1.8%) and urinary retention (0.9%). All patients reported significant pain relief at the time of their postoperative visits. Three patients reported return of pain symptoms within the first seven months after surgery, with one requiring an additional surgery for persistent pain. Conclusions Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is a safe and feasible alternative that provides long-term symptom relief in patients undergoing hysterectomy for a variety of indications.
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Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
| | - Kimsa Nguyen
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
| | - Eliza Ackroyd
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
| | - Robert A Roman
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
| | - Anupama Rambhatla
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
| | - Azadeh Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
| | - Atena Asiaii
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Palo Alto, USA
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24
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Ciebiera M, Łoziński T. The role of magnetic resonance-guided focused ultrasound in fertility-sparing treatment of uterine fibroids-current perspectives. Ecancermedicalscience 2020; 14:1034. [PMID: 32419846 PMCID: PMC7221132 DOI: 10.3332/ecancer.2020.1034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
Uterine fibroids (UFs) are the most common benign tumours of the female reproductive system and the most frequent reason for hysterectomy worldwide. UFs are reported in 20%–70% of women of reproductive age depending on a study group. Although most women with UFs are asymptomatic, over 30% of them will present with different symptoms. Abnormal uterine bleeding, pain, pressure and infertility are the most common. Lesions that cause these kinds of symptoms may require medical intervention. Trends in UF treatment change along with patient awareness and the introduction of new methods and techniques. Selecting an appropriate treatment option should be individualised and adjusted to the patient’s expectations as much as possible. This choice will mostly depend on the patient’s age, UF location, the size and number of lesions, severity of symptoms and, most importantly, the patient’s expectations concerning the preservation of fertility. Observations made for the past few years showed an increasing number of pre- and perimenopausal women who wish to preserve their uterus or decline surgery. In line with current trends and demands in medicine, great importance is attached to the development and upgrade of new minimally invasive or noninvasive procedures in UF therapy. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is not associated with severe destruction of the uterine cavity and walls. For this reason, this method may be considered as a kind of hope in fertility-sparing UF therapy and the data about its use in this indication raises future hope. In this review, we summarise the available data on the use of MR-HIFU as a fertility-sparing method in the treatment of UFs. We also indicate how it could evolve in the future. According to the available data, MR-HIFU is a relatively safe noninvasive method which seems not to deteriorate fertility compared to the pre-treatment status. MR-HIFU may constitute an alternative solution and be chosen in patients who meet the qualification criteria and deny other methods, which also facilitates the use of other treatment options in case the procedure is ineffective. Further randomised studies are necessary to confirm the above information.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynaecology, The Center of Postgraduate Medical Education, Warsaw, Poland.,http://orcid.org/0000-0001-5780-5983
| | - Tomasz Łoziński
- Department of Obstetrics and Gynaecology, Pro-Familia Hospital, Rzeszów, Poland
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Tseng JJ, Huang CC, Chiang HY, Chen YH, Lin CH. Prior uterine myoma and risk of ovarian cancer: a population-based case-control study. J Gynecol Oncol 2020; 30:e72. [PMID: 31328455 PMCID: PMC6658598 DOI: 10.3802/jgo.2019.30.e72] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022] Open
Abstract
Objective Uterine myoma which results in the magnitude of ovarian cancer remains uncertain. This study aimed to assess the association between women with previous uterine myoma and the risk of ovarian cancer. Methods This population-based case-control study was conducted using the Taiwan National Health Insurance Research Database between 2006 and 2010. We identified 4,088 adult women with newly diagnosed ovarian cancer with 16,348 women without ovarian cancer matched for age, urbanization level, income and initial diagnosis date. Logistic regression analyses were used to evaluate the variables associated with ovarian cancer. In addition, the effect of surgical interventions on the risk of ovarian cancer was also evaluated. Results Women with previous uterine myoma were more likely than those who did not to have ovarian cancer (adjusted odds ratio [aOR]=2.26; 95% confidence interval [CI]=2.06−2.49). Patients with uterine myoma who either received (aOR=1.79; 95% CI=1.51−2.13) or did not receive hormone replacement therapy (aOR=2.51; 95% CI=2.24−2.82) experienced a significantly higher risk of ovarian cancer than those without uterine myoma, respectively. However, patients with uterine myoma who underwent either myomectomy (aOR=0.55; 95% CI=0.39−0.77) or hysterectomy (aOR=0.33; 95% CI=0.26−0.42) had a significantly lower risk of ovarian cancer. Conclusion The results revealed that a significantly higher risk of ovarian cancer in women with previous uterine myoma, through an indirect mechanism. Furthermore, a lower risk of ovarian cancer was observed in women who underwent surgical removal of the uterine myoma.
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Affiliation(s)
- Jenn Jhy Tseng
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Chun Che Huang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiu Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi Huei Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Public Health, Fu-Jen Catholic University, New Taipei, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Nezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, Nezhat C. Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management. JSLS 2019; 23:JSLS.2019.00029. [PMID: 31427853 PMCID: PMC6684338 DOI: 10.4293/jsls.2019.00029] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%–10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES). Database: Computerized searches of MEDLINE and PubMed were conducted using the key words “thoracic endometriosis,” “catamenial pneumothorax,” “catamenial hemothorax,” and “catamenial hemoptysis.” References from identified sources were manually searched to allow for a thorough review. Conclusion: TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Dayton, Ohio, USA
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Mailinh Vu
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Nataliya Vang
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Azadeh Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
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Wong SL, To V, Lam J, Lam A. Metastatic neuroendocrine tumour mimicking endometriosis highlights the importance of excision for tissue diagnosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519838717] [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: Endometriosis is a common gynaecological condition, usually presenting with pelvic pain or infertility in women of reproductive age. Diagnosis is made on histopathology of deposits excised during laparoscopy, given diagnosis solely made by macroscopic examination can be challenging for even experienced gynaecological surgeons. Case description: A 45-year-old during laparoscopy for fibroids is found to have peritoneal deposits resembling endometriosis. Histopathology reveals multifocal metastatic grade 1 neuroendocrine tumour of the appendix. Conclusion: This incidental finding highlights the importance of thorough examination of the appendix and abdominal cavity for unexpected pathology during gynaecological laparoscopy. Incidental finding of appendiceal pathology at time of laparoscopy for endometriosis is not uncommon; however, the finding of metastatic malignancy is far rarer. While several case studies have reported severe endometriosis mimicking advanced stage cancer, this is the first documented occurrence of an advanced, metastatic tumour, mimicking endometriosis.
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Affiliation(s)
- Shian-Li Wong
- Centre for Advanced Reproductive Endosurgery, St Leonards, NSW, Australia
| | - Valerie To
- Centre for Advanced Reproductive Endosurgery, St Leonards, NSW, Australia
| | - Justin Lam
- Centre for Advanced Reproductive Endosurgery, St Leonards, NSW, Australia
| | - Alan Lam
- Centre for Advanced Reproductive Endosurgery, St Leonards, NSW, Australia
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To V, Lam A, Shyamsunder A, Johnson N. How feasible and practical is it to introduce the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) standard surgical form into clinical practice? JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518810961] [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
Background: The Endometriosis Phenome and Biobanking Harmonisation Project has been set up to facilitate and advance global endometriosis research. Aim: To test the feasibility and practicality of using the Endometriosis Phenome and Biobanking Harmonisation Project standard surgical form in routine clinical practice. Materials and methods: Standard surgical form was filled out using a web-based application for 225 consecutive women who underwent surgery for suspected or known endometriosis. Results: Median age was 37 years. Half (49.8%) of the women had a previous surgical diagnosis of endometriosis. Endometriosis was found in 91.5% of patients in this cohort. Median operative time was 101 min. Operative photographs substantially assisted completion of the standard surgical form post-operatively. The median time required to fill out the questionnaire was 8 min (range, 2–17 min). This was mostly dependent on the severity and distribution of endometriosis lesions. The standard surgical form is very comprehensive and has the advantage of including both the American Society of Reproductive Medicine classification and the Endometriosis Fertility Index; however, characterisation of deep endometriosis is insufficient for some women. In addition, some sections such as the descriptive endometriosis table (section IX) remain subjective. Conclusion: Using the Endometriosis Phenome and Biobanking Harmonisation Project standard surgical form to collect research data is feasible, especially when using an electronic database entry tool. It is also practically manageable, although the time taken is more than originally estimated by the Endometriosis Phenome and Biobanking Harmonisation Project standard surgical form authors. Even though some sections of the standard surgical form may be subjective, it is comprehensive and we would recommend its adoption into routine clinical practice for endometriosis research.
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Affiliation(s)
- Valerie To
- Centre for Advanced Reproductive Endosurgery, Sydney, NSW, Australia
- Integrated University Health and Social Services Network for Northern Montreal, Montréal, QC, Canada
| | - Alan Lam
- Centre for Advanced Reproductive Endosurgery, Sydney, NSW, Australia
| | | | - Neil Johnson
- Auckland Gynaecology Group, Auckland, New Zealand
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[First line management without IVF of infertility related to endometriosis: Result of medical therapy? Results of ovarian superovulation? Results of intrauterine insemination? CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:331-337. [PMID: 29551300 DOI: 10.1016/j.gofs.2018.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Using the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature. MATERIALS AND METHODS This guideline was produced by a group of experts in the field including a thorough systematic search of the literature (from January 1980 to March 2017). Were included only women with endometriosis related to infertility. For each recommendation, a grade (A-D, where A is the highest quality) was assigned based on the strength of the supporting evidence. RESULTS Management of endometriosis related to infertility should be multidisciplinary and take account into the pain, the global evaluation of infertile couple and the different phenotypes of endometriotic lesions (good practice point). Hormonal treatment for suppression of ovarian function should not prescribe to improve fertility (grade A). After laproscopy for endometriosis related to infertility, the Endometriosis Fertility Index should be used to counsel patients regarding duration of conventional treatments before undergoing ART (grade C). After laparoscopy surgery for infertile women with AFS/ASRM stage I/II endometriosis or superficial peritoneal endometriosis, controlled ovarian stimulation with or without intrauterine insemination could be used to enhance non-ART pregnancy rate (grade C). Gonadotrophins should be the first line therapy for the stimulation (grade B). The number of cycles before referring ART should not exceed up to 6 cycles (good practice point). No recommendation can be performed for non-ART management of deep infiltrating endometriosis or endometrioma, as suitable evidence is lacking. DISCUSSION AND CONCLUSION Non-ART management is a possible option for the management of endometriosis related to infertility. Endometriosis Fertilty Index could be a useful tool for subsequent postoperative fertility management. Controlled ovarian stimulation can be proposed.
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Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril 2018; 109:406-417. [DOI: 10.1016/j.fertnstert.2018.01.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/14/2018] [Accepted: 01/20/2018] [Indexed: 11/28/2022]
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Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci 2017; 60:579-586. [PMID: 29184867 PMCID: PMC5694733 DOI: 10.5468/ogs.2017.60.6.579] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 12/11/2022] Open
Abstract
Objective Adenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women. Methods We used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method. Results A total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis. Conclusion We must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.
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Surgery for endometriosis: beyond medical therapies. Fertil Steril 2017; 107:549-554. [PMID: 28189295 DOI: 10.1016/j.fertnstert.2017.01.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/27/2022]
Abstract
Endometriosis-associated pelvic pain and subfertility may be managed medically in many cases; however, the surgical management of this insidious disease remains a necessary part of the treatment algorithm. Laparoscopy for diagnosis alone is rarely indicated with the advancements in preoperative imaging. When surgery is performed, the ideal goal would be a therapeutic and effective surgical intervention based on the preoperative evaluation. Surgery for women with pain due to endometriosis may be indicated in patients who cannot or do not wish to take medical therapies; acute surgical or pain events; deep endometriosis; during concomitant management of other gynecologic disorders; and patients seeking fertility with pain. The role of surgery for endometriosis-related subfertility may be considered in those with hydrosalpinges undergoing IVF; management of ovarian endometriomas in specific circumstances; and when a patient requests surgery as an alternative to assisted reproductive technology (ART). Surgery for ovarian endometriomas requires special attention due to the risk of potential harm on future fertility. Finally, a combined approach of surgery followed by postoperative medical therapy offers the best long-term outcomes for recurrence of disease and symptoms. A patient-centered approach and a goal-oriented approach are essential when determining the options for care in this population.
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Nezhat F, Apostol R, Greene AD, Pilkinton ML. To Morcellate or Not to Morcellate: A Cross-Sectional Survey Of Gynecologic Surgeons. JSLS 2017; 21:e2016.00092. [PMID: 28144125 PMCID: PMC5266514 DOI: 10.4293/jsls.2016.00092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The inadvertent dissemination of uterine cancer cells with the power morcellator has received much attention in the press and a warning from the U.S. Food and Drug Administration. Many hospitals prohibit the use of the morcellator in gynecologic surgery. We conducted a survey in an attempt to assess gynecologic surgeons' beliefs regarding the intracorporeal power morcellation of fibroids in light of the risk of dissemination of malignancy in patients in whom the presence of cancer is unknown before surgery. METHODS We conducted an Internet-based survey of 3505 members of the Society of Laparoendoscopic Surgeons (SLS) to assess demographics, current use of the intracorporeal power morcellator, and whether the recent negative press has affected gynecologic surgeons' use of the morcellator. RESULTS Of the 3505 SLS members surveyed, 518 responded (response rate, 14.77%). Three hundred thirteen (61%) of the respondents were not using the intracorporeal power morcellator. Of those, 48% reported the reason was a hospital-wide ban, and an additional 17% reported lack of availability (not in stock). Senior attendings with >20 years of experience used the morcellator more often than junior attendings and fellows (P = .007). Furthermore, the morcellator was used significantly less among those with the belief that morcellation of occult malignancy affects survival (P = .013). Three hundred sixty-one (76%) of the participants currently perform laparotomy in fewer than a quarter of their cases; most those cases are still performed using laparoscopic and robot-assisted techniques. CONCLUSION The recent negative press suggesting that intracorporeal power morcellation can disseminate occult malignancy and affect survival has decreased the use of the morcellator. Despite the declining use of power morcellation, most practicing gynecologic surgeons have not converted their procedures to laparotomy.
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Affiliation(s)
- Farr Nezhat
- Department of Obstetrics and Gynecology, Mt Sinai St Luke's and Roosevelt Hospital, New York, New York, USA
| | - Radu Apostol
- Department of Obstetrics and Gynecology, Mt Sinai St Luke's and Roosevelt Hospital, New York, New York, USA
| | - Alexis D Greene
- Department of Obstetrics and Gynecology, Mt Sinai St Luke's and Roosevelt Hospital, New York, New York, USA
| | - Marjorie L Pilkinton
- Department of Obstetrics and Gynecology, North Shore-Long Island Jewish Health System, Great Neck, New York, USA
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