Imaging in gynecological disease (21): clinical and ultrasound characteristics of accessory cavitated uterine malformations.

OBJECTIVE: To describe the clinical and ultrasound characteristics of accessory cavitated uterine malformations (ACUMs). METHODS: This was a single-center observational study of consecutive patients diagnosed with an ACUM, who had undergone an ultrasound examination by an experienced ultrasound examiner between January 2013 and May 2019, identified retrospectively from medical records. ACUM was diagnosed when a cavitated lesion with a myometrial mantle and echogenic contents was seen within the anterolateral wall of the myometrium beneath the insertion of the round ligament. In all women, presenting symptoms and clinical history were recorded along with detailed descriptions of the lesions and any concomitant pelvic abnormalities. RESULTS: Twenty patients diagnosed with an ACUM were identified. Median age was 29.2 (interquartile range, 25.0-35.8) years. None of the women was premenarchal or postmenopausal. All of the women reported painful periods or pelvic pain and none of them reported subfertility. Twelve of the ACUMs were in the right anterolateral myometrium and eight were in the left anterolateral myometrium. Both a myometrial mantle and a fluid-filled cavity were considered to be defining features on ultrasound. The fluid contained within the cavity was either echogenic with a ground-glass appearance or hyperechoic. All of the lesions were spherical in shape. The Doppler flow seen in the outer rim was not markedly different from that of the surrounding myometrium, and the content of the cavity was avascular on Doppler examination. The mean outer cavity diameter of the ACUMs was 22.8 (95% CI, 20.9-24.8) mm and the mean internal cavity diameter was 14.1 (95% CI, 12.2-16.1) mm. Four women opted for transvaginal ultrasound-guided alcohol sclerotherapy. Surgical excision was carried out in eight cases, and the diagnosis was confirmed on histopathological examination in all of them. CONCLUSIONS: ACUMs are a uterine abnormality with a distinct ultrasound appearance, which are associated with dysmenorrhea and chronic pelvic pain. Knowledge of their typical appearance on ultrasound could facilitate early detection and treatment. There are several treatment options for ACUM, ranging from simple analgesia to complete excision. Further prospective and longitudinal studies are required to study the prevalence and natural history of this condition. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

[Robotic-assisted laparoscopy for deep infiltrating endometriosis: the Register of the Society of European Robotic Gynaecological Surgery]. / Place de la robotique dans l'endométriose pelvienne profonde : à propos du registre de la SERGS.

OBJECTIVES: To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. PATIENTS AND METHODS: From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. RESULTS: In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. DISCUSSION AND CONCLUSION: This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed.

Long-term follow up of uterine artery embolisation--an effective alternative in the treatment of fibroids.

OBJECTIVES: To evaluate the long-term efficacy and complications of uterine artery embolisation (UAE) for treatment of symptomatic uterine fibroids. DESIGN: A prospective observational study. SETTING: A district general hospital and two private hospitals in the southeast of England. POPULATION: Women with symptomatic fibroids who had been offered surgical options for treatment. METHODS: Postal questionnaire follow up at 5-7 years to assess long-term clinical effects among women who had undergone UAE. MAIN OUTCOME MEASURES: The questionnaire was subdivided into sections dealing with menstrual flow, amenorrhoea and menopause, fibroid-related symptoms, fertility, vaginal discharge, sexual function, subsequent treatments for fibroids and satisfaction with the procedure. RESULTS: A total of 258 women were identified as being between 5 and 7 years post-UAE and suitable for long-term follow up in October 2004. One hundred seventy-two completed questionnaires were analysed (67% response rate). Seventy-five percent of women still had either a return to normal or an improvement in menstrual flow compared with how they were prior to UAE. More than 80% of fibroid-related symptoms were still resolved or improved. Sixteen percent of women required further treatment for fibroids. Premature menopause directly following UAE occurred in only one woman in the study group. Eighty-eight percent of women were satisfied with the outcome of the procedure at 5-7 years and would choose it again or recommend it to others. CONCLUSIONS: These findings show that UAE is of benefit to women wishing to avoid hysterectomy and it carries a low risk of complications.