Parametrial Endometriosis Part 2:Clinical Diagnosis and Correlation of Medical Imaging with Laparoscopic Findings

Abstract

Study Objective This is the second video of a series introducing the concept of parametrial endometriosis (PE) and describing our approach to diagnosing and treating this particular disease presentation. The objective of this video is to discuss the presenting signs and symptoms associated to this condition as well as provide an approach for clinical workup and diagnosis. We introduce diagnostic imaging and correlate these images with live surgical footage. Design Educational video that discusses the diagnosis and workup of PE, a specific pattern of endometriosis with a unique constellation of symptoms. Setting Compilation of anatomy schematics, diagnostic imaging, and surgical video clips from a tertiary center demonstrating the clinical and surgical findings that may be present with PE. Patients or Participants This video is part of an ongoing retrospective-prospective study that currently includes 28 patients who underwent surgical parametrectomies for the treatment of PE. Diagnostic images and surgical video segments have been extracted from such patients. Interventions Anatomy schematics, medical imaging and surgical video clips demonstrating the anatomy, clinical and diagnostic findings, and describing the infiltration patterns of PE. We then present some pictorial cases correlating the clinical, imaging and surgical findings. Measurements and Main Results PE infiltrates towards the pelvic sidewall and intrapelvic portions of the lumbosacral plexus producing symptoms such as lateral hip, sacral, groin and posterior thigh pain. It is often associated with neuropathic symptoms such as pudendal neuralgia, sciatica, urinary urgency and frequency, dischezia and proctalgia. Conclusion PE is a unique presentation of endometriosis with a specific constellation of symptoms and clinical findings. This video series introduces this concept and teaches the approach to clinical diagnosis setting the bases for the next video in the series, which describes the surgical technique and results of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) of PE.