Rectovaginal endometriosis: head to head comparison between sonovaginography and magnetic resonance imaging

A Andrisani,A Vitagliano,F Dessole,G Ambrosini,G Capobianco,G Virdis,L Marin,R Cappadona,S Dessole

doi:10.12891/ceog5083.2019

Abstract

Background: Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis associated with dysmenorrhoea, pelvic pain, and dyspareunia. Diagnosis of RVE is a challenge for clinicians. Aim of outhe present study was to compare the diagnostic accuracy of sonovaginography with MRI on a consecutive cohort of women referred to this institution due to RVE suspect. Materials and Methods: The authors performed a retrospective study on consecutive patients undergoing surgery at this Unit due to a suspicion of RVE. All women were subject to MRI and sonovaginography. Primary endpoint was to compare the diagnostic accuracy of sonovaginography and MRI in the detection of RVE. Results: RVE was diagnosed (with surgery plus histology) in 60 women. In all cases, the surgical procedure was completed without complications. Sonovaginography and MRI showed high sensitivity (95% vs. 81.7%) and similar specificity (93.8% and 91.2%, respectively) in the diagnosis of RVE. Conclusions: Sonovaginography, when performed by an expert sonographer, may represent a valid alternative to MRI for the diagnosis of RVE, with lower costs and minimal time consumption.

Highlights

Deep endometriosis (DPE) is arbitrarily defined as an endometriotic lesion that infiltrates the peritoneum by more than 5 mm [1, 2]
Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis which affects between 3.8% and 31.4% of all women suffering from endometriosis
RVE often presents with symptoms including dysmenorrhoea, pelvic pain, and dyspareunia

Summary

Introduction

Deep endometriosis (DPE) is arbitrarily defined as an endometriotic lesion that infiltrates the peritoneum by more than 5 mm [1, 2]. Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis which affects between 3.8% and 31.4% of all women suffering from endometriosis. RVE infiltrates the rectovaginal septum and can obliterate the pouch of Douglas [3, 4]. RVE often presents with symptoms including dysmenorrhoea, pelvic pain, and dyspareunia. It can cause non-specific clinical manifestations like back pain, change in posture and bowel symptoms, resulting in a delayed diagnosis [5, 6]. Therapy for RVE comprises different drugs (i.e. progestogens, estro-progestin, androgens, GnRH analogues) and surgery. Medical therapy is temporarily effective in controlling pain, while surgery (when a complete excision of endometriotic nodule is achieved) is associated with a long-term pain resolution and a significant improvement in patient’s quality of life [7, 8]

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Methods

Conclusion