Surgical Correction and Rehabilitation of Patients with Congenital Uterovaginal Anomalies and Concomitant Genital Endometriosis

Abstract

Study Objective To evaluate the results of surgical treatment and rehabilitation in patients with uterovaginal anomalies and concomitant external genital endometriosis. Design Prospective cohort study. Level II-1. Setting Federal State Budget Institution «Research Center for Obstetrics, Gynecology and Perinatology» Ministry of Healthcare of the Russian Federation. Patients or Participants Since 2013 to 2019 we examined 198 patients with various uterovaginal anomalies. The 1st group included 105 patients with concomitant endometriosis, the 2d consisted of 93 patients without endometriosis. Interventions Surgical treatment of uterovaginal anomalies was made according to the anatomical type of malformation, clinical manifestations and reproductive outcomes. In cases with concomitant endometriosis we made excision and coagulation of endometriotic lesions. Measurements and Main Results The prevalence of primary infertility was significantly higher in 1st group- 55.5%, compared with the 2d group - 25.3% (p = 0.0057). The index of dysmenorrhea was significantly higher in 1-st group - 53.3%, compared with the control group -36, 6% (p = 0.0179). The frequency of external genital endometriosis was 53%. In 20% of patients with aplasia of the uterus and vagina without functional rudimental horns endometriotic lesions were visualized on pelvic peritoneum. Conclusion The laparoscopy revealed no significant differences in the incidence of endometriosis among patients with and without outflow obstruction of menstrual blood. Sampson's theory of retrograde menstruation doesn't explain the development of endometriosis in all patients with uterovaginal anomalies. Comprehensive treatment, including surgical correction of the anatomic type of malformation, with incision and coagulation of endometriotic lesions helped to get pregnancy in 60% of patients.