Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 93
Filter
1.
J Turk Ger Gynecol Assoc ; 23(3): 145-153, 2022 09 05.
Article in English | MEDLINE | ID: mdl-36065973

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.

2.
J Minim Invasive Gynecol ; 29(5): 584-585, 2022 05.
Article in English | MEDLINE | ID: mdl-35247606

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 owing to endometriosis. SETTING: Tertiary care university hospital. A patient written consent was obtained on March 9, 2021. The local institutional review board 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, among 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].


Subject(s)
Endometriosis , Laparoscopy , Ureter , Urinary Bladder Diseases , Cystectomy , Endometriosis/surgery , Female , Humans , Male , Ureter/surgery , Urinary Bladder Diseases/surgery
3.
J Gynecol Oncol ; 33(1): e10, 2022 01.
Article in English | MEDLINE | ID: mdl-34910391

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. METHODS: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. RESULTS: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). CONCLUSION: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic.


Subject(s)
COVID-19 , Endometrial Neoplasms , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/therapy , Female , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
4.
J Minim Invasive Gynecol ; 29(2): 291-299.e1, 2022 02.
Article in English | MEDLINE | ID: mdl-34464760

ABSTRACT

STUDY OBJECTIVE: To evaluate the ultrasound features, types, and degrees of adenomyosis among adolescents and to correlate these findings with clinical symptoms DESIGN: A retrospective observational study. SETTING: Gynecological ultrasound units from January 2014 to June 2020. PATIENTS: A total of 43 adolescents (aged 12-20 years) who were diagnosed as having adenomyosis at a pelvic ultrasound examination. INTERVENTIONS: Ultrasound features and location and type of adenomyosis within the uterus were evaluated on stored 2-dimensional images and videos and 3-dimensional volumes. Adenomyosis was classified as mild, moderate, and severe according to the extension of the disease in the uterus as described in our previous published classification. MEASUREMENTS AND MAIN RESULTS: Adenomyotic features recorded among our population were myometrial hyperechoic areas, uterine wall asymmetry, intramyometrial cystic areas, and some types of junctional zone alterations. The posterior uterine wall (58%) and the outer myometrial layer (93%) were mostly affected. In 44% of adolescents (19/43) with adenomyosis, at least 1 location of pelvic endometriosis was documented. Dysmenorrhea was the most commonly reported symptoms (88%), and it was associated with adenomyosis of the outer myometrium, myometrial hyperechoic areas, uterine wall asymmetry, and intramyometrial cystic areas. Adolescents with dyspareunia showed diffuse adenomyosis (9/9 patients) including both the inner and outer myometrium (7/9 patients) and in the posterior wall (7/9 patients). Heavy menstrual bleeding was associated with diffuse adenomyosis (18/23 patients) mostly of the outer myometrium (22/23 patients). Scoring system showed predominantly mild disease and no severe adenomyosis was found. Adolescents with diffuse adenomyosis were significantly older and showed a high percentage of heavy menstrual bleeding compared with those with the focal disease of the inner myometrium. CONCLUSION: This study shows that adenomyosis is not only a pathology of adult life, but it involves young patients mostly in a mild-to-moderate form and is associated with typical painful symptoms. In adolescents, the diagnosis of adenomyosis is feasible through a noninvasive way with ultrasound and a proper management can be set.


Subject(s)
Adenomyosis , Endometriosis , Adenomyosis/complications , Adenomyosis/diagnostic imaging , Adolescent , Adult , Child , Dysmenorrhea/diagnostic imaging , Dysmenorrhea/etiology , Endometriosis/pathology , Female , Humans , Myometrium/diagnostic imaging , Myometrium/pathology , Ultrasonography/methods , Uterus/diagnostic imaging , Uterus/pathology , Young Adult
5.
Gynecol Endocrinol ; 37(7): 577-583, 2021 Jul.
Article in English | MEDLINE | ID: mdl-33587014

ABSTRACT

OBJECTIVE: Adenomyosis is a benign uterine disorder characterized by the invasion of the endometrium within the myometrium, starting from the junctional zone (JZ), the inner hormone dependent layer of the myometrium that plays an important role in sperm transport, implantation and placentation. The resulting histological abnormalities and functional defects may represent the pathogenic substrate for infertility and pregnancy complications. The objective of this paper is to review the literature to evaluate the correlation between inner myometrium alterations and infertility and to assess the role of JZ in the origin of adverse obstetric outcomes of both spontaneous and in vitro fertilization (IVF) pregnancies. METHODS: we searched Pubmed for all original and review articles in the English language from January1962 until December 2019, using the MeSH terms of 'adenomyosis', 'junctional zone', combined with 'infertility', 'obstetrical outcomes', 'spontaneous conception', 'in vitro fertilization' and 'classification'. The review was divided into three sections to assess this pathogenic correlation, evaluating also the importance of classification of the disease. RESULTS AND CONCLUSIONS: Absent or incomplete remodeling of the JZ can affect uterine peristalsis, alter vascular plasticity of the spiral arteries and activate inflammatory pathways, all related to adverse obstetric outcomes. Despite these observations, there is still limited evidence whether adenomyosis is a cause of infertility. However, it is reasonable to screen patients for adenomyosis, to consider pregnant women with diffuse adenomyosis at high risk of adverse obstetric outcomes, and to evaluate the importance of a noninvasive validated classification in the management of women with adenomyosis.


Subject(s)
Adenomyosis/pathology , Endometrium/pathology , Infertility, Female/physiopathology , Myometrium/pathology , Pregnancy Complications/pathology , Adenomyosis/classification , Adenomyosis/diagnostic imaging , Adenomyosis/physiopathology , Endometrium/diagnostic imaging , Female , Fertilization in Vitro , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Myometrium/diagnostic imaging , Pregnancy , Pregnancy Complications/classification , Pregnancy Complications/diagnostic imaging , Pregnancy Complications/physiopathology , Pregnancy Outcome , Risk Assessment , Ultrasonography , Ultrasonography, Prenatal
7.
Fertil Steril ; 114(5): 1049-1057, 2020 11.
Article in English | MEDLINE | ID: mdl-33036795

ABSTRACT

OBJECTIVE: To evaluate the ultrasonographic presence of different forms of endometriosis and the associated clinical symptoms in adolescent women. DESIGN: Retrospective observational study. SETTING: University hospital. PATIENT(S): Two hundred and seventy women aged 12-20 years referred to the gynecologic ultrasound unit from January 2014 to June 2019. INTERVENTION(S): Two-dimensional, three-dimensional, and power Doppler ultrasound (US) pelvic examination (transvaginal or transrectal in pre-sexually active adolescents) were performed in all included adolescents. Medical history was collected for each patient before the scan. MAIN OUTCOME MEASURE(S): All possible locations of endometriosis evaluated and recorded using a dedicated ultrasound mapping sheet and severity of painful symptoms evaluated through a visual analogue scale (VAS). RESULT(S): Dysmenorrhea was detected in 147 (54.4%) of 270 patients and heavy menstrual bleeding in 76 (28.1%) of 270. At least one ultrasound feature of endometriosis was identified in 36 (13.3%) of 270 cases. Ovarian endometriomas were found in 22 (11%) patients, adenomyosis in 16 (5.2%), and deep infiltrating endometriosis (DIE) in 10 (3.7%). Ultrasound signs of endometriosis were found in 21% of adolescents who reported dysmenorrhea and 33% with dyspareunia. The presence of DIE at ultrasound was associated with bowel symptoms in 33% of patients and associated with dyspareunia in 25% of patients. CONCLUSION(S): The detection rate of pelvic endometriotic lesions at ultrasound was 13%. The rates of dysmenorrhea, dyspareunia and heavy menstrual bleeding in adolescents with endometriosis ultrasound signs were statistically significantly higher compared with those without. In patients with dysmenorrhea, the detection rate of pelvic endometriosis at ultrasound increased to 20%. Professionals involved with teens should be aware of the clinical presentation of endometriosis to reduce the delay between the onset of symptoms and the diagnosis, referring these young women to dedicated centers.


Subject(s)
Endometriosis/diagnostic imaging , Endometriosis/epidemiology , Ultrasonography, Doppler/methods , Adolescent , Age Factors , Child , Dysmenorrhea/diagnostic imaging , Dysmenorrhea/epidemiology , Early Diagnosis , Female , Humans , Pelvic Pain/diagnostic imaging , Pelvic Pain/epidemiology , Retrospective Studies , Young Adult
8.
J Ultrasound Med ; 40(6): 1219-1228, 2021 Jun.
Article in English | MEDLINE | ID: mdl-32936475

ABSTRACT

OBJECTIVES: To evaluate transvaginal ultrasound (TVUS) findings in patients who underwent segmental rectosigmoid resection for deep infiltrating endometriosis (DIE) and to correlate postsurgical ultrasound findings with symptoms. METHODS: A retrospective study including 50 premenopausal women with bowel endometriosis who underwent segmental rectosigmoid resection was conducted. Within 12 months after surgery, a TVUS examination was conducted in all patients to evaluate the presence of postsurgical endometriosis locations and symptoms, including dysmenorrhea, dyspareunia, dysuria, dyschezia, and chronic pelvic pain. Pelvic pain was assessed in all women by a visual analog scale. RESULTS: At the follow-up 32 of 50 patients were receiving medical treatment, whereas 18 women declined postsurgical medical therapy and tried to conceive. A high percentage of adhesions (90%) was found. A negative sliding sign (a simple diagnostic sign that can be performed during a TVUS examination, consisting of gentle pressure applied by both the vaginal transducer and the examiner's hand on the abdomen; if the uterus does not glide freely along with the rectum and posterior fornix, the sign is considered negative, and adhesions can be suspected) was found in 29 (58%) women and was associated with bowel symptoms. Recurrence of posterior DIE was found in 9 cases (18%) and endometriomas in 8 cases (16%). Adenomyosis was observed in 80% of women and was present in all symptomatic patients. CONCLUSIONS: After rectosigmoid segmental resection patients with DIE may continue to be symptomatic, and postoperative TVUS may reveal foci of disease or pelvic adhesions. Moreover, adenomyosis could be linked to symptoms experienced during follow up. Women should be aware that painful symptoms and alterations of pelvic organs could still be present after surgery and be detectable by TVUS.


Subject(s)
Endometriosis , Laparoscopy , Endometriosis/diagnostic imaging , Endometriosis/surgery , Female , Humans , Rectum/diagnostic imaging , Rectum/surgery , Retrospective Studies , Ultrasonography
9.
Med Hypotheses ; 143: 109833, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32498005

ABSTRACT

Adenomyosis is characterized by the presence of ectopic endometrium within the myometrium. This features lead to structural changes in the surrounding myometrium and endometrium resulting also in functional changes. Alterations in the myometrium are suspected to lead to defective remodeling of spiral arteries during the early stages of decidualization resulting in altered vascular resistance and defective placentation. These alterations could play a common part in the association between adenomyosis and major obstetric complications. Latest epidemiological studies show that adenomyosis is associated with preterm birth, preeclampsia, IUGR and increased caesarean section rates, but very little is known of any underlying mechanism linking postpartum hemorrhage and adenomyosis. It is our opinion that adenomyosis may increase the risk of postpartum hemorrhage through several mechanisms that will be further clarified. Women with adenomyosis may require specific management during pregnancy and may benefit from wider understanding of the pathological mechanisms associated with this disease process.


Subject(s)
Adenomyosis , Postpartum Hemorrhage , Premature Birth , Cesarean Section , Endometrium , Female , Humans , Infant, Newborn , Myometrium , Postpartum Hemorrhage/etiology , Pregnancy
10.
Panminerva Med ; 63(2): 224-231, 2021 Jun.
Article in English | MEDLINE | ID: mdl-32414232

ABSTRACT

The present study aimed to analyze the litigation trends and ensuing compensatory damages brought about by the use of episiotomy, in order to outline a set of cautionary rules meant to limit the scope of legreal aftermath for both doctors and health care facilities. The authors have set out to gain an insight into the controversial practice of episiotomy, in light of available research data and official positions of various scientific and medical associations, with a close focus on the legal and medical viability of the procedure itself. Court data and trial records have been taken into account as well, via searches into legal databases and search engines (Justia, Lexis, Jurist.org, Venice Courthouse, etc.). This review showed that most episiotomy-related lawsuits stemmed from a routine use of that procedure, which is almost universally advised against, and without valid informed consent having been gained. Ultimately, authors have seen fit to underscore the need for patients potentially eligible for an episiotomy (selective episiotomy) to receive thorough and understandable information in a timely fashion including the necessity and the effectiveness of the procedure as well as the risks involved, so that a well-informed decision can be made based on factual data.


Subject(s)
Episiotomy , Informed Consent , Natural Childbirth , Obstetric Labor Complications/etiology , Episiotomy/adverse effects , Episiotomy/legislation & jurisprudence , Episiotomy/methods , Female , Humans , Liability, Legal , Malpractice , Obstetric Labor Complications/prevention & control , Pregnancy
11.
J Obstet Gynaecol ; 41(1): 7-20, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32312121

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.


Subject(s)
Abdomen, Acute/diagnosis , Endometriosis/diagnosis , Abdomen, Acute/etiology , Acute Disease , Adult , Diagnosis, Differential , Diagnostic Errors , Dysmenorrhea/diagnosis , Dysmenorrhea/etiology , Endometriosis/complications , Female , Humans
13.
Int J Womens Health ; 12: 35-47, 2020.
Article in English | MEDLINE | ID: mdl-32099483

ABSTRACT

Endometriosis is a chronic condition primarily affecting young women of reproductive age. Although some women with bowel endometriosis may be asymptomatic patients typically report a myriad of symptoms such as alteration in bowel habits (constipation/diarrhoea) dyschezia, dysmenorrhoea and dyspareunia in addition to infertility. To date, there are no clear guidelines on the evaluation of patients with suspected bowel endometriosis. Several techniques have been proposed including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema. These different imaging modalities provide greater information regarding presence, location and extent of endometriosis ensuring patients are adequately informed whilst also optimizing preoperative planning. In cases where surgical management is indicated, surgery should be performed by experienced surgeons, in centres with access to multidisciplinary care. Treatment should be tailored according to patient symptoms and wishes with a view to excising as much disease as possible, whilst at the same time preserving organ function. In this review article current perspectives on diagnosis and management of bowel endometriosis are discussed.

14.
J Minim Invasive Gynecol ; 27(3): 583-592, 2020.
Article in English | MEDLINE | ID: mdl-31954185

ABSTRACT

Power morcellation in laparoscopic surgery enables specialists to carry out minimally invasive procedures such as hysterectomies and myomectomies by cutting specimens into smaller pieces using a rotating blade and removing pieces through a laparoscope. Unexpected uterine sarcoma treated by surgery involving tumor disruption could be associated with poor prognosis. The current study aims to shed light on power morcellation from a medicolegal perspective: the procedure has resulted in adverse outcomes and litigation, and compensation for plaintiffs, as published in various journals cited in PubMed and MEDLINE, Cochrane Library, EMBASE, and GyneWeb. Considering the claims after the US Food and Drug Administration warnings on morcellation, the current study broadens the scope of research by including search engines, legal databases, and court filings (DeJure, Lexis Nexis, Justia, superior court of New Jersey, and US district court of Minnesota) between 1995 and 2019. Legal records show that courts determine professional responsibility regarding complications, making it essential to document adherence to safety protocols and specific guidelines, when available. Sound medical practices and clearly stated institute best practices result in better patient outcomes and are important when unfavorable clinical outcomes occur; adverse legal decisions can be avoided if there are grounds to prove professional conformity with specific guidelines and the unpredictability of an event.


Subject(s)
Gynecology/legislation & jurisprudence , Liability, Legal , Morcellation/legislation & jurisprudence , Uterine Myomectomy/legislation & jurisprudence , Uterine Neoplasms/surgery , Female , Gynecology/statistics & numerical data , History, 20th Century , History, 21st Century , Humans , Hysterectomy/instrumentation , Hysterectomy/legislation & jurisprudence , Hysterectomy/methods , Jurisprudence/history , Laparoscopy/instrumentation , Laparoscopy/legislation & jurisprudence , Laparoscopy/methods , Liability, Legal/history , Morcellation/instrumentation , Morcellation/methods , Physician-Patient Relations , Practice Patterns, Physicians'/legislation & jurisprudence , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Prognosis , Sarcoma/diagnosis , Sarcoma/epidemiology , Sarcoma/surgery , Treatment Outcome , United States/epidemiology , United States Food and Drug Administration , Uterine Myomectomy/instrumentation , Uterine Myomectomy/methods , Uterine Neoplasms/diagnosis , Uterine Neoplasms/epidemiology
15.
J Minim Invasive Gynecol ; 27(6): 1254-1255, 2020.
Article in English | MEDLINE | ID: mdl-31838275

ABSTRACT

STUDY OBJECTIVE: To show the safety and feasibility of laparoscopic sacrohysteropexy for treating uterine prolapse. DESIGN: An educational video to explain the laparoscopic steps of this procedure by focusing on the main anatomic landmarks and on tips and tricks to avoid complications. SETTING: A tertiary care university hospital. INTERVENTIONS: Laparoscopic sacropexy with uterus preservation for grade 3 apical defect. CONCLUSION: This video shows a stepwise approach to laparoscopic sacrohysteropexy demonstrating its feasibility and safety. There is a wide choice of surgical procedures and approaches focused on pelvic organ prolapse repair. Since many years, uterine prolapse has been an indication for hysterectomy, regardless of the occurrence of uterine disease and patients' desires. With the introduction of minimally invasive surgery, the uterine-sparing procedures are being increasingly taken into account, especially in young women [1]. Sacrohysteropexy is a uterus-sparing procedure that allows for a reduction in operating time, intraoperative blood loss, mesh-related complications, and surgical costs [2]. Furthermore, this technique has a high success rate with an objective cure rate of 100% for the apical compartment and 80% for all compartments and does not seem to increase the pelvic organ prolapse recurrence rate [3]. Sacropexy is not a life-threatening procedure, but its main objective is to restore functional anatomy with the primary goal of improvement in patient's quality of life. Moreove, no difference has been found with or without uterus preservation in term of postoperative recurrence rate or ent's quality of life [4]. However, high patient satisfaction has been recently reported; therefore, uterine preservation should be considered during patient's counseling.


Subject(s)
Gynecologic Surgical Procedures/methods , Laparoscopy/methods , Organ Sparing Treatments/methods , Uterine Prolapse/surgery , Uterus/surgery , Adult , Blood Loss, Surgical/prevention & control , Female , Humans , Hysterectomy/methods , Middle Aged , Operative Time , Quality of Life , Reconstructive Surgical Procedures , Surgical Mesh , Treatment Outcome , Uterus/pathology
17.
J Minim Invasive Gynecol ; 27(6): 1308-1315, 2020.
Article in English | MEDLINE | ID: mdl-31600574

ABSTRACT

STUDY OBJECTIVE: To correlate the type and degree of adenomyosis, scored through a new system based on the features of transvaginal sonography, to patients' symptoms and fertility. DESIGN: This is a multicenter, observational, prospective study. SETTING: Two endometriosis tertiary referral centers (University of Rome "Tor Vergata" and University of Siena). PATIENTS: A total of 108 patients with ultrasonographic signs of adenomyosis. INTERVENTIONS: A new ultrasonographic scoring system designed to assess the severity and the extent of uterine adenomyosis was used to stage the disease in correlation with the clinical symptoms. Menstrual uterine bleeding was assessed by a pictorial blood loss analysis chart, painful symptoms were evaluated using a visual analog scale, and infertility factors were considered. MEASUREMENTS AND MAIN RESULTS: A total of 108 patients with ultrasonographic signs of adenomyosis (mean age ± standard deviation, 37.7 ± 7.7 years) were classified according to the proposed scoring system. Women with ultrasound diagnosis of diffuse adenomyosis were older (p = .04) and had heavier menstrual bleeding (p = .04) than women with focal disease; however, no statistically significant differences were found regarding the presence and severity of dyspareunia and dysmenorrhea. Higher values of menstrual bleeding were found for severe diffuse adenomyosis, with the highest values being found in those with adenomyomas. In patients trying to conceive, the presence of ultrasound findings of focal disease was associated with a higher percentage of infertility than in those with diffuse disease, and the focal involvement of the junctional zone showed a higher percentage of at least 1 miscarriage than in those with diffuse adenomyosis. CONCLUSION: The ultrasonographic evaluation of the type and extension of adenomyosis in the myometrium seems to be important in correlation to the severity of symptoms and infertility.


Subject(s)
Adenomyosis/classification , Adenomyosis/diagnosis , Diagnostic Techniques, Obstetrical and Gynecological , Ultrasonography , Adenomyosis/complications , Adenomyosis/pathology , Adult , Dysmenorrhea/diagnosis , Dysmenorrhea/etiology , Female , Humans , Menorrhagia/diagnosis , Menorrhagia/etiology , Middle Aged , Myometrium/diagnostic imaging , Pain Measurement , Prospective Studies , Severity of Illness Index , Ultrasonography/methods , Uterine Hemorrhage/diagnosis , Uterine Hemorrhage/etiology
18.
JSLS ; 22(4)2018.
Article in English | MEDLINE | ID: mdl-30662252

ABSTRACT

Background and Objectives: Laparoscopic surgical excision of bladder nodules has been demonstrated to be effective in relieving associated painful symptoms; the data are lacking concerning the impact of anterior compartment endometriosis on infertility. We conducted this study to evaluate whether or not the surgical excision of deep endometriosis affecting the anterior compartment plays a role in restoring fertility. Methods: This multicentre, retrospective study included a group of 55 patients presenting with otherwise-unexplained infertility who had undergone laparoscopic excision of anterior compartment endometriosis with histological confirmation. Patient medical records and operative reports were reviewed. Telephone interviews were conducted for long-term followup of fertility outcomes. Results: The pregnancy rate following surgical excision of endometriotic lesions was 44% (n = 11) among those with anterior compartment involvement alone and 50% (n = 15) in case of posterior lesions association without any significant difference. The symptoms related to bladder endometriosis resolved in the 84.2% of the cases with a recurrence rate of 1.8% at the 2-year followup not requiring further surgery. Conclusion: Laparoscopic excision of anterior compartment endometriosis is effective in restoring fertility in patients with otherwise-unexplained infertility and in treating endometriosis-related symptoms.


Subject(s)
Endometriosis/surgery , Infertility, Female/etiology , Infertility, Female/surgery , Pregnancy Rate , Adult , Female , Humans , Laparoscopy , Pregnancy , Retrospective Studies
19.
Fertil Steril ; 110(6): 1154-1161.e3, 2018 11.
Article in English | MEDLINE | ID: mdl-30396560

ABSTRACT

OBJECTIVE: To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis. DESIGN: Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience. SETTING: University hospital. PATIENTS: Seventy consecutive women who underwent transvaginal ultrasound for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility. INTERVENTION: Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity of adenomyosis was described using a new schematic scoring system that describes the extension of the disease considering all possible ultrasound adenomyosis features. MAIN OUTCOME MEASURES: Reproducibility of the new mapping system for adenomyosis and rate agreement between two operators. RESULTS: Multiple rate agreements to classify the different features and the score of adenomyosis (diffuse, focal adenomyoma, and focal or diffuse alteration of junctional zone) ranged from substantial to almost perfect (Cohen κ = 0.658 - 1) except for adenomyoma score 4 (one or more adenomyomas with the largest diameter >40 mm) in which interobserver agreement was moderate (κ = 0.479). CONCLUSION: Our new scoring system for uterine adenomyosis is reproducible and could be useful in clinical practice. The standardization of the transvaginal approach and of the sonographer training represent a crucial point for a correct diagnosis of myometrial disease.


Subject(s)
Adenomyosis/classification , Adenomyosis/diagnostic imaging , Myometrium/diagnostic imaging , Ultrasonography, Doppler/classification , Ultrasonography, Doppler/standards , Adult , Female , Gynecology/classification , Gynecology/standards , Humans , Middle Aged , Observer Variation , Prospective Studies , Reproducibility of Results , Single-Blind Method
20.
Gynecol Endocrinol ; 35(3): 207-210, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30382803

ABSTRACT

Ulipristal acetate (UPA) is used for medical treatment of uterine fibroids. The aim of this study was to describe the effects on painful symptoms and the sonographic uterine modifications in patients with adenomyosis erroneously treated with UPA. This is an observational study on six women affected by adenomyosis and treated with three months of UPA (5 mg/24h). The baseline ultrasonography (US) was not performed at out center nor was the diagnosis of fibroids. The patients came to our attention after the treatment with UPA, prescribed by an external physician. During our post-treatment scan we found aspects of adenomyosis, while no fibroids were detected. Symptoms, myometrial and endometrial ultrasound features were evaluated. All patients reported an increase in pelvic pain. At US evaluation intramyometrial cystic areas were found in all six cases (100%). All patients showed an enhancement of adenomyosis features.The intra-myometrial cysts appeared enlarged and the vascularization enhanced when compared to the images of the pretreatment scan. In patients with adenomyosis treated with UPA due to an erroneous diagnosis of uterine fibroids we observed a worsening of the US features of adenomyosis and of the painful symptoms.


Subject(s)
Adenomyosis/diagnostic imaging , Leiomyoma/drug therapy , Norpregnadienes/therapeutic use , Ultrasonography , Uterine Neoplasms/drug therapy , Uterus/diagnostic imaging , Diagnostic Errors , Disease Progression , Female , Humans , Leiomyoma/diagnostic imaging , Middle Aged , Norpregnadienes/pharmacology , Uterine Neoplasms/diagnostic imaging , Uterus/drug effects
SELECTION OF CITATIONS
SEARCH DETAIL