Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis.

Stacy Young,Lucia Difrancesco,Azadeh Nezhat,Camran Nezhat,Megan Kennedy Burns

doi:10.4274/jtgga.2017.0143

Stacy Young, Lucia Difrancesco + Show 3 more

Open Access

https://doi.org/10.4274/jtgga.2017.0143

Copy DOI

Abstract

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.

Highlights

It is important to thoroughly evaluate the patient for gastrointestinal and genitourinary endometriosis, especially if deeply infiltrative endometriosis (DIE) is present on physical exam
Ultrasound is sufficiently sensitive for diagnosis of pelvic DIE and bladder endometriosis; magnetic resonance imaging (MRI) or i.v pyelogram is often needed to evaluate the intestines or ureter
Medical management should be tried first due to the risk of postoperative complications associated with injury to the nervus plexi supplying the lower rectum

Summary

Introduction

Endometriosis affects up to 10% of all reproductive-age women, and affects approximately 35-50% of women with pelvic pain and infertility [1]. Bowel Endometriosis: Safe Endoscopic Excision of Deep Infiltrating Extragenital Endometriosis, https://www.youtube.com/ watch?time_continue=2&v=inUVHCLzrQQ, Feb 8, 2107): Shaving excision Shaving excision is the most conservative approach to surgical management of bowel endometriosis It is performed through progressive layer-by-layer removal of diseased bowel until underlying healthy tissue is reached. The aim is to remove as much endometriosis and fibrosis as possible, and restore a normal anatomic architecture without entering the bowel lumen (4146) This technique is associated with lower complication rates compared with the other two techniques [44,45,46,47], and is recommended for lesions below the sigmoid colon owing to the abundant vasculature and nervous plexi supplying the lower rectum [38]

Disc excision

Ureteral endometriosis

Bladder endometriosis

Findings

Conclusion