Management Of Ovarian Endometrioma Research Articles

Factors Influencing Postoperative Recurrence and Live Birth Achievement after Laparoscopic Surgery for Ovarian Endometrioma: A Retrospective Study in a Regional Core Hospital

Background: Ovarian endometrioma (OMA) is a common gynecological condition affecting women of reproductive age, often requiring laparoscopic surgery for removal. However, the management of OMA, including postoperative hormone therapy, is complex and must be tailored to the individual's conditions. Therefore, to provide meaningful insights, we aimed to analyze 10 years of accumulated data from patients who underwent laparoscopic surgery for OMA, with a primary focus mainly on postoperative OMA recurrence and live birth outcomes. Methods: We reviewed the medical records of 158 patients who underwent laparoscopic surgery for OMA, including total laparoscopic cystectomy (TLC) (79 patients), total laparoscopic adnexectomy (TLA) (62 patients), or both unilateral TLA and contralateral TLC (17 patients), between January 2014 and December 2023. Among the OMA patients, we identified 7 cases of postoperative OMA recurrence out of 158 patients, and 23 live births among 79 TLC patients. We performed a multivariate logistic regression analysis to assess the impact of each representative factor on postoperative OMA recurrence and live birth achievement. Results: The multivariate analyses of the 158 patients revealed that advance age and massive blood loss were significantly associated with an increased risk of postoperative OMA recurrence, while postoperative hormone treatment was associated with a decreased risk of recurrence. In the analysis of live birth achievement among the 79 TLC patients, advanced age, postoperative hormone treatment and cancer antigen 125 (CA125) positivity were significantly associated with a reduced likelihood of achieving live birth. Conclusions: Our data highlight the unfavorable effects of advanced age, massive blood loss and CA125 positivity on the outcomes of laparoscopic surgery for OMA. Additionally, postoperative hormone treatment was found to decrease postoperative OMA recurrence. These findings may offer more accurate information to guidance in selecting treatment options for patients with OMA.

Ultrasound study of natural progression of ovarian endometrioma.

To determine the natural progression of ovarian endometrioma in women who are managed expectantly. This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26-51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49-71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1-5) and the median follow-up time was 634 (range, 187-2984) days. A total of 39/83 (47% (95% CI, 36-58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13-32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22-42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was -2.7 (range, -57.7 to 39.3) mm, with a median annual regression rate of -1.7 (range, -24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow-up (median diameter, 22.3 (range, 6.7-77.0) mm vs 18.5 (range, 5.0-72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ethanol Sclerotherapy in the Management of Ovarian Endometrioma: Technical Considerations for Catheter- and Needle-Directed Sclerotherapy

PurposeTo provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods.Materials and MethodsFrom January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity.ResultsBoth needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05).ConclusionThe choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity.Level of evidence Level 3, non-controlled retrospective cohort study.Graphical

Management of Dysmenorrhea due to Ovarian Endometrioma w.s.r to Vatika Artavadushti by Ayurvedic Regime - A Case Report

Endometriomas are cystic lesions that stem from the disease process of endometriosis. Ovary is the most common site for endometriosis (60-70%) and dysmenorrhea is its commonest manifestation. Dysmenorrhea means painful menstruation. Therefore in Ayurveda this condition can be correlated with Vatika Artavadushti as painful menses (Vata vedana) is mentioned as one of the main characteristic feature of it according to Acharya Sushruta. Hereby, reporting a case of 24 year old unmarried female who visited Prasutitantra and Striroga OPD at National Institute of Ayurveda, Jaipur. Main Clinical Findings: Patient presented with the complaints of painful and scanty menses along with vomiting and fever during menstrual days since 1.5 years. Patient also added that she was having dark brown colored menses. Ultrasonography dated 03rd December 2021 suggested bilateral enlarged ovaries with small left ovarian endometrioma. Diagnosis: On the basis of these clinical presentations and ultrasonography findings patient was diagnosed with Ovarian Endometrioma and was further correlated with Vatika artavadushti as mentioned in Ayurveda classics. Intervention: As vitiation of Vata dosha is main causative factor for all these symptoms, treatment of same was of prime importance. Ashtang Sangraha while explaining the management of Vatika Artavadushti have mentioned Kashmarya-Kshudrasaha Ksheerapaka as one of the treatment modality. Hence it was taken as the drug of choice. Outcome: After 2 months of treatment an ultrasound was repeated which showed no any impression of Ovarian Endometrioma. Conclusion: Kashmarya-Kshudrasaha Ksheerapaka is found effective in the management of Ovarian Endometrioma. The purpose of this study is to report the potential of Kashmarya-Kshudrasaha Ksheerapaka in the management of painful menses due to ovarian endometrioma along with its effect on dark brown colored and scanty menses with special reference to Vatika artavadushti.

Ethanol Sclerotherapy versus Laparoscopic Surgery in Management of Ovarian Endometrioma; a Randomized Clinical Trial.

Introduction:A variety of therapeutic modalities are available in management of ovarian endometrioma. This study aimed to compare the effects of ethanol sclerotherapy and laparoscopic surgery on disease recurrence and ovarian factors of these patients.Methods:70 women with ovarian endometrioma and chronic pelvic pain were randomly divided into two groups. The first group underwent sclerotherapy with a puncture needle (cook) and the second group underwent laparoscopic surgery. Both groups were followed up every three months to investigate the recurrence rate. In this regard, ultrasonography was performed 3 months and 12 months after treatment, and serum anti-Müllerian hormone (AMH) levels were also reassessed 12 weeks after the intervention.Results:70 women with the mean age of 31.46 ± 4.71 years, and the mean body mass index (BMI) of 23.12 ± 1.01 were studied. The two groups were similar regarding age (p = 0.770), BMI (p = 0.371), history of gastrointestinal signs (p = 0.794), history of urinary diseases (p = 0.324), dysmenorrhea (p = 0.403), pelvic pain (p = 0.454), dyspareunia (p = 0.448), location of cyst (p = 0.448), and diameter of cyst (p = 0.250). In the laparoscopic group, a significant decrease in anti-Müllerian hormone (AMH) levels was observed after 12 weeks (p < 0.0001), while in the sclerotherapy group, no significant changes were found between pre-and post-operative AMH levels (p = 0.120). Cyst size decreased significantly in both groups three months (p < 0.001) and twelve months (p < 0.0001) after treatment. In the third month, 8 patients in the sclerotherapy group and 13 patients in the laparoscopic group had recurrences, and in the twelfth month, 17 patients in the sclerotherapy group and 15 patients in the laparoscopic group had recurrence of symptoms (p > 0.05).Conclusions:Although AMH level and mean cyst diameter were significantly lower one year after laparoscopy, recurrence rate of ovarian endometrioma was similar between ethanol sclerotherapy and laparoscopy methods.

Sclerotherapy with Leuprolide and Cefoperazone Sulbactam in the Management of Ovarian Endometriomas under Ultrasound Guidance: A Novel Approach

Endometriosis is an estrogen dependent gynecological disorder, which can occur throughout the reproductive age of women, causing chronic pelvic pain, substantial morbidity, and impaired fertility. It is clinically defined as the presence of ectopic endometrium resulting in sustained inflammatory reaction. In India, about 29,000,000 women suffer from endometriosis. Severe pelvic pain and recurrent endometriomas were observed even after surgery. We have conducted aspirations totally in 110 patients in which most of the patients were suffering from Stage III & Stage IV of endometriosis except for 7 patients for whom we have done as primary therapy for endometriomas. Among 110 patients, 4 patients didn’t turn up for follow up after first aspiration. This pilot study conducted with 110 patients in Ponni Hospital and Fertility Research Centre, Madurai aimed to evaluate pregnancy outcome in 51 infertile patients, and to alleviate pelvic pain, to restore a healthy sexual life and to reduce the recurrence rate of Ovarian Endometriomas (OE) in 59 patients, who did not seek fertility, After using the newer sclerosing agent Leuprolide with Cefoperazone Sulbactam (LCS) under ultrasound guidance. This prospective pilot study resulted in a highly significant achievement in pregnancy where 41 patients conceived out of 51 patients (80.39%) only 6 are in ongoing treatment. Those who didn’t seek fertility were 59 of which 43 have completed family 13 have one child and 3 unmarried girls. 96.61% were relieved of pain and recurrence and restored healthy sexual life, 2 are in ongoing treatment. We have not encountered any adverse effects during this treatment.

Management of Ovarian Endometrioma in Asymptomatic Reproductive Age Women

Management of Ovarian Endometrioma in Asymptomatic Reproductive Age Women

Tumour markers and histopathologic features of ovarian endometriotic cysts

Endometriosis is one of the most common benign gynaecologic diseases and its clinical presentation is generally ovarian endometrioma. We aimed to assess the association of tumour markers with histopathological structure of ovarian endometriomas to assess their roles in clinical management. Data from 86 women who underwent laparoscopic surgery for ovarian endometrioma were evaluated. The possible risk factors for inadvertently removed normal ovarian parenchyma (IRNOP) during laparoscopic cystectomy and the relationship between tumour markers and histopathologic parameters of ovarian endometrioma were assessed. Age and the depth of penetration of endometrial tissue into the cyst wall showed a significant positive correlation with thickness of IRNOP. There was a significant negative correlation between IRNOP and the thickness of fibrosis on cyst wall. Thickness of fibrosis and the depth of penetration represented significant positive correlations with tumour markers (CA 125, CA 15-3, and CA 19-9), respectively. This is the first study that reveals the association between tumour markers and the histopathologic features of ovarian endometrioma. The outcome of the present study indicated that lower levels of tumour markers may permit a conservative management, rising levels may help in timing of a possible surgical intervention and high levels may help in counselling postoperative outcomes. Impact statement What is already known on this subject? Endometriosis is defined as a benign gynaecologic disease, and the vast majority of women who suffer from endometriosis are of reproductive age. Ovarian endometriotic cysts are found in one-fifth to one-half of patients with endometriosis. Laparoscopic cystectomy is accepted as the gold standard for the surgical management of ovarian endometriotic cysts because of the procedure’s several clinical advantages, such as lower recurrence and higher pregnancy rates. However, studies have indicated that laparoscopic excision of an ovarian endometrioma capsule could be associated with a reduction in both the ovarian volume and the follicle count. What do the results of this study add? Our retrospective data indicate that tumour markers may have role in planning the management of ovarian endometriomas. What are the implications of these findings for clinical practice and/or further research? Low tumour markers levels may permit a conservative management, elevating levels may help in timing of a possible surgical intervention and finally high levels may help in counselling the patient about her possible postoperative outcomes.

Management of ovarian endometriomas: many options…but difficult decisions

Management of ovarian endometriomas: many options…but difficult decisions

Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis

To evaluate the efficacy of sclerotherapy for ovarian endometrioma on the risk of recurrence, clinical symptoms, and reproductive function. Systematic review and meta-analysis. Not applicable. Patients who underwent sclerotherapy of ovarian endometrioma. An electronic-based search with the use of Pubmed, Embase, Ovid Medline, Google Scholar, Clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials. Recurrence rate, symptoms relief, fertility outcome, and adverse events. Eighteen studies were included in our review. The overall recurrence rates of endometrioma after sclerotherapy ranged from 0 to 62.5%. The risk of recurrence was significantly higher in women who were treated by means of ethanol washing than by means of ethanol retention. The number of oocytes retrieved was higher after endometrioma sclerotherapy compared with laparoscopic cystectomy, but clinical pregnancy rates were similar. There was no difference in the number of oocytes retrieved and the clinical pregnancy rates between the sclerotherapy-treated group with and the untreated group. Sclerotherapy for ovarian endometrioma may be considered in symptomatic women who plan to conceive.

Management of Ovarian Endometrioma by Single Incision Laparoscopic Surgery: Case Series

To describe the experience of gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery.

Fertility Outcomes After Ablation Using Plasma Energy Versus Cystectomy in Infertile Women With Ovarian Endometrioma: A Multicentric Comparative Study

Study ObjectiveTo compare the probability of postoperative pregnancy in infertile women with ovarian endometrioma larger than 3 cm in diameter, managed by either ablation using plasma energy or cystectomy. DesignA multicentric case-control study (Canadian Task Force classification II-2). SettingSix surgical departments, affiliated with 4 university hospitals and 2 private facilities. PatientsOne hundred four infertile patients with ovarian endometrioma larger than 3 cm. InterventionsEndometrioma ablation using plasma energy was performed in 64 patients (61.5%) and cystectomy in 40 patients (38.5%). Measurements and Main ResultsPatients were enrolled in the CIRENDO prospective cohort database (NCT02294825) from June 2009 to June 2014 and managed in 6 different facilities. The minimum length of follow-up was 1 year. Postoperative probabilities of pregnancy in patietns and control subjects were estimated using the Kaplan-Meier method with 95% confidence intervals (CIs) and compared using the log-rank test. The Cox model was used to assess independent predictive factors for pregnancy. Patients managed by plasma energy were significantly older than patients managed by cystectomy, had significantly higher overall revised American Fertility Society (rAFS) score, and had higher rate of Douglas pouch obliteration, deep endometriosis, and colorectal localizations. After a mean follow-up of 35.3 ± 17.5 months (range, 12–60), fertility outcomes were comparable between the groups. The probability of pregnancy at 24 and 36 months after surgery in plasma energy and cystectomy groups was, respectively, 61.3% (95% CI, 48.2%–74.4%) versus 69.3% (95% CI, 54.5%–83%) and 84.4% (95% CI, 72%–93.4%) versus 78.3% (95% CI, 63.8%–90%). The Cox's model revealed that the type of surgical procedure on ovarian endometrioma had no statistically significant impact on the probability of pregnancy, after adjustment for women's age, bilateral cysts larger than 3 cm, colorectal endometriosis, and rAFS stage of endometriosis. ConclusionPostoperative pregnancy rates were comparable after management of ovarian endometrioma by either ablation using plasma energy or cystectomy despite an overall higher rate of unfavorable fertility predictive factors in women managed by ablation.

Ovarian cystectomy in endometriomas: Combined approach.

Endometrioma is one of the most frequent adnexal masses in the premenopausal population, but the recommended treatment is still a subject of debate. Medical therapy is inefficient and can not be recommended in the management of ovarian endometriomas. The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent. While the surgical treatment of choice is surgical laparoscopy, for conservative treatment, the preferred method is modified combined cystectomy. Cystectomy can be destructive for the ovary, whereas ablation may be incomplete, with a greater risk of recurrence. To the best of our knowledge, the modified combined technique seems to be more efficient in the treatment of endometriomas.

Postoperative Recurrence and Fertility after Endometrioma Ablation Using Plasma Energy: Retrospective Assessment of a 3-Year Experience

Study ObjectiveTo assess recurrence and pregnancy rates in women with ovarian endometrioma treated via ablation using plasma energy. DesignRetrospective non-comparative pilot study including 55 patients treated during 28 months, with prospective recording of data (Canadian Task Force classification II-2). SettingTertiary referral center. PatientsFifty-five consecutive women with pelvic endometriosis in whom ovarian endometriomas were managed solely via ablation using plasma energy. The minimum follow-up was 1 year. InterventionEndometrioma ablation using plasma energy. Measurements and Main ResultsInformation was obtained from the database of the North-West Inter Regional Female Cohort for Patients with Endometriosis, based on self-questionnaires completed before surgery, surgical and histologic data, and systematic recording of recurrences, pregnancy, and symptoms. Recurrences were assessed using pelvic ultrasound examination. Mean (SD) follow-up was 20.6 (7.2) months (range, 12–39 months). In 75% of patients, deep infiltrating endometriosis was treated, and 40% had colorectal involvement. Preoperative infertility was recorded in 42% of patients. The rate of postoperative recurrence was 10.9% for the entire series. Of 33 women who wished to conceive, 67% became pregnant, spontaneously in 59%. Time from surgery to the first pregnancy was 7.6 (4.3) months. After discontinuation of postoperative hormone therapy, the probability of not conceiving at 12 months was 0.36 (95% confidence interval, 0.19–0.53), and at 24 months was 0.27 (95% confidence interval, 0.12–0.44). ConclusionsRecurrence and pregnancy rates are encouraging in that they seem comparable to the best reported results after endometrioma cystectomy. Plasma energy may have an important role in the management of ovarian endometrioma in women seeking to conceive. Patients most in need of surgical procedures that can spare ovarian parenchyma, such as those with bilateral endometriomas or a history of ovarian surgery, may particularly benefit from ablation using plasma energy.

Management of Ovarian Endometrioma

The optimal conservative treatment for endometriotic cysts is unclear, particularly when treated laparoscopically. We performed a systematic analysis of the published literature on ovarian endometrioma especially focused on comparing laparoscopic cystectomy with laparoscopic drainage and coagulation of the cyst with regard to evaluating advantage and disadvantage of each method. We observed that cystectomy was superior in terms of risk of recurrent symptoms, cyst, reoperation, pregnancy: this was true in both prospective and retrospective studies previously published. Given the evidence available, excision of cyst wall in endometrioma is strongly recommended especially in infertile patients.

A prospective randomized open study comparing goserelin (Zoladex) plus surgery and surgery alone in the management of ovarian endometriomas

ObjectiveTo determine whether goserelin (ZoladexTM; AstraZeneca, London, UK), plus surgery offers advantages over surgery alone in the management of ovarian endometriomas.DesignProspective, multicentre, randomized, open‐label, parallel‐group study.InterventionsFollowing preoperative aspiration of endometriomas, they were sized by ultrasound, a diagnosis of endometriosis confirmed by laparoscopy and its severity assessed. Patients were stratified according to endometrioma size and randomly allocated to one of two groups: group 1 (G1; n = 21) received a monthly (every 28 days) subcutaneous injection of goserelin 3.6 mg for 3 months (12 weeks); group 2 (G2; n = 27) received no treatment. At 3 months, the size of endometriomas was reassessed in both groups before definitive excision. Both groups were reassessed at 6 months postsurgery.Main outcome measuresChange in size of the largest endometrioma from entry to just prior to excision.ResultsThe mean change in endometrioma size was −2.29 cm in G1 and −1.29 cm in G2. The resulting (adjusted) mean difference of −1.25 cm was statistically significant in favour of G1 (P = 0.036, 95% CI −2.42 to −0.08 cm). Very difficult surgery was reported in four (22%) patients in G1 and 10 (46%) patients in G2. Mean duration of surgery was 74.2 min in G1 and 86.4 min in G2. There was a trend towards a greater reduction in mean Additive Diameter of Implants (ADI) score at 6 months postsurgery in G1 compared with G2 (−65.9 vs. −56.6). Both groups were comparable in terms of the number of complete excisions of their endometrial cysts at surgery, blood loss at surgery, Revised American Fertility Society (R‐AFS) scores and pelvic symptoms. Goserelin was well tolerated.ConclusionsLaparoscopic aspiration of endometriomas followed by a monthly goserelin 3.6 mg depot for 3 months compared with laparoscopic aspiration alone results in significantly smaller endometriomas at 3 months and a trend towards a greater reduction in ADI score.