Recurrence Of Ovarian Endometrioma Research Articles

Ovarian endometrioma recurrence after laparoscopic surgery: First assessment of ACSAP predicting score.

We aimed to develop and validate a predictive score to estimate the post-operative recurrence risk after laparoscopic excision of ovarian endometrioma (OMA). The prediction score was developed using a training set comprising 431 patients with OMA who underwent laparoscopic surgery at our institution between January 2015 and September 2017. A follow-up period of at least 5 years was required. Clinical data were entered into least absolute shrinkage and selection operator (LASSO) regression to build a scoring system that predicted OMA recurrence. A testing set containing 185 patients from October 2017 to October 2018 was used to assess its performance. Based on LASSO regression, the final score (ACSAP score) included five clinical predictors (0-15 points): Age, cyst size, previous surgery for OMA, revised American Society for Reproductive Medicine stage and post-operative pregnancy. The area under the curve values of the score were 0.741 (0.765) and 0.727 (0.795) for predicting 3-year and 5-year OMA recurrence, respectively, in the training (testing) set. The score stratified patients into three risk groups in both sets, with significant differences in the 5-year recurrence rates (low-risk, 5.3% [0%]; intermediate-risk, 20.2% [16.5%] and high-risk, 48.0% [36.5%]; P < 0.001). Moreover, patients in the intermediate- and high-risk groups exhibited a significant reduction in the 5-year cumulative recurrence following a minimum of 15-month post-operative medical treatment (both P < 0.05). The ACSAP score may be a concise and useful tool for identifying patients with a higher risk of OMA recurrence after surgery who might receive long-term post-operative medical treatment.

Analysis of Risk Factors for Bleeding and Recurrence of Ovarian Endometriomas after Laparoscopic Surgery and Its Impact on Pregnancy Outcomes

Analysis of Risk Factors for Bleeding and Recurrence of Ovarian Endometriomas after Laparoscopic Surgery and Its Impact on Pregnancy Outcomes

Use of Oxidized Regenerated Cellulose (ORC) in treatment of ovarian endometriomas to prevent recurrence and preserve ovarian reserve

Background: Oxidized Regenerated Cellulose (ORC) is used in the treatment of Endometriosis to eliminate or postpone endometriomas’ recurrence and to preserve ovarian reserve subsequently increasing pregnancy rate. The aim of this research was to evaluate the benefit of ORC in surgical management of ovarian endometriomas to reduce the rate of recurrence while preserving ovarian reserve. Methods: This prospective randomized controlled research was carried out on 60 cases, divided into two groups: Group A (drainage and ablation): 30 cases had laparoscopic drainage of ovarian endometrioma with electrocautery of the endometriomal cyst wall. Group B (drainage and ORC): 30 cases had laparoscopic drainage of ovarian endometrioma with insertion of ORC inside the cyst cavity. Results: There was a statistically significant difference according to 3 and 6 months in anti-mullerian hormone (AMH) (ng/ml) and Antral Follicular Count (AFC) being higher in ORC group compared to ablation group while the reduction in AMH (change) was significantly lower in ORC group (P values< 0.001). The recurrence rate of ovarian endometrioma was comparable between both groups. AMH and AFC was significantly associated with the recurrence of ovarian endometrioma 3 and 6 months. Conclusions: ORC reduces effectively the recurrence risk of endometriomas following laparoscopic drainage.

Risk factors for coexisting deep endometriosis for patients with recurrent ovarian endometrioma.

The aim of this study was to assess the risk factors for coexisting deep endometriosis (DE) in patients with recurrent ovarian endometrioma (OE). We retrospectively reviewed 151 recurrent OE patients who had been diagnosed of OE but not DE at the time of their first surgery and then received a second surgery for recurrent endometriosis with or without DE. Their clinical characteristics at the time of the first and second surgeries were collected. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for coexisting DE in patients with recurrent OE. Among the 151 recurrent OE patients, 46 were diagnosed of DE during the recurrent surgery and included in the DE group, while the remaining 105 patients were included in the non-DE group. In univariate analysis, there were significant differences in terms of uterine retroversion during the primary surgery and the follow-up time after the primary surgery between the DE and non-DE groups. The multivariate analysis also showed that both uterine retroversion and the follow-up time (≥5 years) were associated with the coexistence of DE during the recurrent surgery. The odds ratio (OR) for uterine retroversion was 3.72 [95% confidence interval (CI) 1.62-8.53], and the OR for follow-up time (≥5 years) was 5.03 (95% CI 2.29-11.02). Our study suggested that for recurrent OE patients, uterine retroversion during the first surgery and a follow-up time of at least 5 years are risk factors for the coexistence of DE in recurrent surgery, early prevention and full preparation before the recurrent surgery should be emphasized in these conditions.

Extrinsic Adenomyosis Is Associated With Postoperative Recurrence of Ovarian Endometrioma.

Objective: To determine whether endometrioma recurrence is closely related to the presence of extrinsic adenomyosis, which was demonstrated by magnetic resonance imaging (MRI).Design: Observational crosssectional study involving patients with the recurrence of ovarian endometrioma (OMA). Correlations of endometrioma recurrence and adenomyosis subtypes shown by MRI were analyzed.Method: Between January 2018 and December 2020, a total of 233 patients with recurrence of OMA after ovarian cystectomy were administered for surgery at our institution. All patients were divided into subtype II (Group A), subtype I+IV (Group B), and nonadenomyosis (Group C) groups at preoperative MRI imaging. The correlations of endometrioma recurrence with clinical features, imaging appearance, and surgical findings were retrospectively analyzed.Results: We found 112 (48.07%) patients of endometrioma recurrence combined with subtype II adenomyosis, 8 (3.43%) subtype I adenomyosis, 47 (20.17%) subtype IV adenomyosis, 66 (28.32%) nonadenomyosis. The mean time of OMA recurrence (44.28 ± 8.37, vs. 63.96 ± 10.28, vs. 69.36 ± 9.34 mon), rate of pain symptoms (85.71, vs. 69.10, vs. 18.18%), and primary infertility (31.25, vs. 14.55, vs. 10.77%) were higher in Group A. Uterine volume (257.37± 42.61, vs. 203.14 ± 33.52, vs. 100.85 ± 26.67 cm3), and mean OMA size (4.97 ± 2.25, vs. 4.36 ± 2.38, vs. 4.46 ± 2.70 cm) were significantly larger in Group A. The rate of DIE (83.93, vs. 45.45, vs. 40.91%), the number of DIE (3.6 ± 1.8 vs. 2.3 ± 1.5 vs. 2.2 ± 1.3), the mean total revised American Society for Reproductive Medicine score (rASRM, 103.14 ± 23.89 vs. 74.23 ± 16.72 vs. 36.51 ± 14.23) were significantly higher in Group A. After a multiple logistic regression analysis, extrinsic adenomyosis (OR 2.5, 95% CI 1.2–3.4), DIE lesions (OR 2.1, 95% CI 1.4–2.8), and primary infertility (OR 1.8, 95% CI 1.3–4.3) were significantly associated with early recurrence (in 3-year) of OMA.Conclusions: Extrinsic adenomyosis was associated with postoperative recurrence of OMA. In addition, a pathogenic link between extrinsic adenomyosis and pelvic endometriosis needs to be clarified.

Comparing the effect of adjunctive N-acetylcysteine plus low dose contraceptive with low dose contraceptive alone on recurrence of ovarian endometrioma and chronic pelvic pain after conservative laparoscopic surgery: a randomised clinical trial study

This study aimed to compare the effectiveness of NAC plus low dose contraceptive with low dose contraceptives alone. This was a randomised trial on a sample of women who underwent conservative laparoscopic surgery for ovarian endometrioma. Patients were randomly assigned either to the NAC plus low dose contraceptive group (n = 48) or low dose contraceptive alone (n = 52). To evaluate the recurrence rate transvaginal ultrasound was performed. Pelvic pain was assessed using a visual analogue scale (VAS). All assessments were performed at two points in time: 3 and 6 months post-surgery and compared between the two regimens. The findings indicated that reduction in the recurrence rate of endometrioma and pelvic pain were similar between both groups. The findings showed that adding N-acetylcysteine to low dose contraceptive treatment has a similar effect in reducing the recurrence rate of endometrioma and pelvic pain when compared to low dose contraceptives alone. Impact statement What is already known on this subject? Endometriosis is a frequent benign disease-producing inflammatory response with mild to severe symptoms. Although surgical removal of ectopic lesions is the first-line intervention, the recurrence rate of the disease is high. Thus this study aimed to compare the effectiveness of N-acetylcysteine plus low dose contraceptive with low dose contraceptive alone. What do the results of this study add? The findings showed that adding N-acetylcysteine to low dose contraceptive treatment has a similar effect in reducing the recurrence rate of endometrioma and pelvic pain when compared to low dose contraceptives alone. What are the implications of these findings for clinical practice and/or further research? It is recommended to increase the duration of drug administration in future studies

Recurrent ovarian endometrioma after conservative surgery

Objective: To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy. Methods: This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018. The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery. Nineteen factors were collected for risk evaluation. The prevalence of recurrent ovarian endometrioma and its 95% confident interval (CI) were calculated. Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence. Results: Recurrent ovarian endometrioma occurred in 33% (95% CI 27.7%-38.3%) patients. The median duration of follow-up was 36 months. during the median follow-up period of 36 months. Preoperative history of parity, preoperative infertility history, endometriosis surgery, moderate to severe dysmenorrhea, dyspareunia, intraoperative stage 4 according to revised American Society for Reproductive Medicine classification, presence of adenomyosis, and postoperative pain relief were associated factors based on univariate analysis. In contrast, infertility [odds ratio (OR) 2.22, 95% CI 1.14-4.33], moderate to severe dysmenorrhea (OR 2.13, 95% CI 1.09-4.15), and postoperative pelvic pain relief (OR 0.22, 95% CI 0.12-0.42) were independently associated factors based on multivariable logistic regression analysis. Conclusions: In our setting, preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk. In contrast, postoperative pain relief was significantly associated with lower recurrence risk.

Risk factors for the development of ovarian endometrioma recurrence after surgical treatment in metropolitan areas

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ факторов риска, связанных с рецидивом эндометриомы яичника среди женщин — жительниц мегаполиса (Екатеринбург), прооперированных по поводу эндометриоидной кисты яичника. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В ретроспективное исследование были включены 95 пациенток репродуктивного возраста, перенесших лапароскопическую цистэктомию яичников по поводу эндометриом. Рецидив эндометриомы определялся при контрольном трансвагинальном ультразвуковом исследовании. <h3>РЕЗУЛЬТАТЫ</h3> Общее число рецидивов составило 13 (13,7%) из 95. Средний возраст пациенток в группе с рецидивами был статистически значимо меньше — 26,8±4,0 года против 33,3±7,0 года в группе без рецидива (<i>p</i>=0,002), индекс массы тела — ниже — Me 19 [17,5; 21,0] против Me 28,0 [22,0; 32,0] кг/м² (<i>p</i>&lt;0,001), уровень онкомаркера СА-125 после оперативного лечения выше — 42,7 [35,4; 48,8] ед/мл против 13,9 [9,4; 17,9] ед/мл в группе без рецидивов (<i>p</i>&lt;0,001). В группе с рецидивом также чаще выявлялась диспареуния (<i>p</i>&lt;0,001) и был больше средний размер эндометриомы (<i>p</i>=0,005). Многомерный анализ показал, что наличие хронической тазовой боли, мажущих кровянистых выделений вне менструации в анамнезе, дисменореи, двустороннего поражения яичников, аденомиоза, гипотиреоза коррелировало с повышенным риском развития рецидива эндометриомы после оперативного лечения, а назначение комбинированных пероральных контрацептивов или диеногеста в послеоперационном периоде снижало вероятность рецидива. <h3>ЗАКЛЮЧЕНИЕ</h3> Установлено, что вероятность рецидива эндометриомы после оперативного лечения в условиях крупного города составляет 13,7%. Перечисленные анамнестические параметры, клинические проявления и данные лабораторных показателей могут использоваться для прогнозирования риска рецидива эндометриомы яичника.

RECURRENCE, RE-OPERATION, AND PREGNANCY RATES AFTER SURGICALLY TREATED OVARIAN ENDOMETRIOMA IN A SINGLE INSTITUTION: LONG-TERM FOLLOW UP OF 756 WOMEN

The aims of this study were to evaluate the cumulative recurrence, re-operation, and pregnancy rates after surgically treated ovarian endometrioma in a single institution for more than a 5-year follow up period. This was a retrospective chart review of the patients with ovarian endometrioma who underwent surgery between January 2008 and March 2016. Study subjects included premenopausal women with at least 5-years of follow-up. Exclusion criteria were patients with stage I or II ovarian endometrioma by revised American Society for Reproductive Medicine (rASRM) classification, those who underwent hysterectomy or bilateral oophorectomy, and presence of residual ovarian lesions on the first postoperative ultrasonography at 3-6 months. Recurrent ovarian endometrioma was defined as a new cystic mass measuring 20 mm or more on the ultrasonography. A total of 756 patients were recruited. The mean age was 31.8±6.3 years (median 31 years, range, 16-54 years) and the mean follow-up duration was 90.4±23.3 months (median 85.5 months, range, 60-155 months). Recurrent ovarian endometrioma was detected in 27.9% (211 of 756 patients), and re-operation was performed in 8.3% (63 of 756 patients). Total 29.9% (63 of 211 patients) with recurrent endometrioma was treated with repeated surgery. Using the Kaplan-Meier method, the cumulative recurrence rate at 24, 36, 60, and 120 months after surgical treatment of ovarian endometrioma was calculated as 5.9%, 8.7%, 15.5% and 37.8%, respectively. The cumulative re-operation rate at 24, 36, 60, and 120 months was 0.3%, 1.1%, 3.1% and 15.6%, respectively. After multivariate analyses, age ≤ 31 years (hazard ratio [HR]=2.108; 95% confidence interval [CI]=1.522-2.921; p<0.001), no subsequent pregnancy (HR=1.851; 95% CI=1.309-2.617, p<0.001), postoperative hormonal treatment ≤15 months (HR=2.869; 95% CI=2.088-3.941); p<0.001) were significant risk factors for recurrent ovarian endometrioma. Among the study patients, 316 (41.7%) women desired future pregnancy, and 171 of 316 (54.1%) were able to conceive and had uncomplicated delivery. Eighteen (5.7%) women experienced spontaneous abortion or ectopic pregnancy, and 36 (11.4%) women were either pregnant at the time of data collection or lost to follow up after confirming intrauterine pregnancy. Among the 316 patients who desired pregnancy, 91 (28.8%) failed to conceive. Considering the fact that longer postoperative hormonal treatment is the sole modifiable factor for recurrent ovarian endometrioma, we recommend long-term hormonal treatment until subsequent pregnancy, especially in younger age group.

Risk factors for ovarian endometrioma recurrence following surgical excision: a systematic review andmeta‑analysis.

Exploring potential risk factors for OMA recurrence, thereby contributing to the individual management of the disease and improving the patients' prognosis. Data sources PubMed, Embase, the Cochrane Library, CNKI, and Wanfang data were searched systematically before October 2020. We computed the pooled odd ratios or the standard mean difference with their corresponding 95% confidence interval to investigate the impact of involved risk factors on endometrioma recurrence. The pooled findings of this meta-analysis demonstrated that endometrioma relapse was closely related to age at surgery [SMD (95% CI): -0.28 (--0.38 to -0.17), P < 0.00001], CA125 level [SMD (95% CI): 0.51 (0.14-0.88), P = 0.007], cyst size [SMD (95% CI): 0.35 (0.08-0.62), P = 0.01], dysmenorrhea [OR (95% CI): 1.47 (1.07-2.02), P = 0.02], endometriosis-related surgery history [OR (95% CI): 2.60 (1.84-3.67), P < 0.00001], pre-operative medication [OR (95% CI): 2.13 (1.41-3.22), P = 0.0003], rASRM score [SMD (95% CI): 0.33 (0.20-0.46), P < 0.00001]. Furthermore, post-operative pregnancy was indicated a protective factor for preventing the OMA recurrence after surgery [OR (95% CI): 0.22 (0.09-0.56), P = 0.001] CONCLUSION: Age at surgery, CA125 level, cyst size, dysmenorrhea, endometriosis-related surgery history, pre-operative medication, rASRM score were risk factors for endometrioma relapse. In addition, post-operative pregnancy was a protective factor for preventing recurrence after surgery. However, the effect of bilateral involvement, combination with adenomyosis, or post-operative medication on endometrioma relapse need further investigations.

Risk factors for recurrence of ovarian endometriomas after surgical treatment: retrospective cohort study

Aim. To identify risk factors for recurrence of ovarian endometriomas after surgical treatment. Materials and methods. The retrospective cohort study included 82 patients operated on for the first time for ovarian endometriomas, the follow-up period was 30 months. The recurrence developed in 19 patients (group 1), in 63 the recurrence was not diagnosed (group 2). Data prior to surgery (clinical characteristics, level CA-125), during surgery (cytokine concentration in peritoneal fluid, immunohistochemical analysis in capsule of ovarian endometriomas), postoperative therapy were evaluated as risk factors for recurrence. The Mann-Whitney U-test, the Fisher exact test was used to compare the groups. Specificity, sensitivity, accuracy, AUC ROC and threshold values were calculated. Results. The recurrence rate of ovarian endometriomas was 23%. There were no differences between groups according to age, proportion of smokers, body mass index, gynecological anamnesis, obstetric status and postoperative hormone therapy. Preoperative concentrations of CA-125 in group 1 were higher than in group 2: 62.5 U/ml [40.7; 112.3] vs 40.3 U/ml [20.3; 68.8], р &lt; 0.05. The concentration of IL-6, IL-8, TNFα, IL-1β, IL-17, VEGF, MCP 1 in peritoneal fluid taken during surgery was statistically significantly higher in group 1. The highest AUC ROC was received for VEGF 0.875 (0.778–0.973) and IL-8 0.953 (0.896–1.009). For VEGF the threshold value was 125.6 pg/ml, sensitivity 100%, specificity 71%, accuracy 79.8%. For IL-8 the threshold value was 128.78 pg/ml, sensitivity 93%, specificity 87.1%, accuracy 88.9%. In group 1, higher expression values of VEGF and CD34 angiogenesis markers in ovarian endometriomas were recorded. The highest AUC ROC was noted for CD34 — 0.844 (0.683–1.000), threshold value was 2.5%, sensitivity 90%, specificity 75%, accuracy 80.8%. Conclusion. Risk factors for recurrence of ovarian endometriomas after operative treatment include VEGF and IL-8 levels in peritoneal fluid and expression of CD34 in the capsule.

Ovarian endometriosis associated infertility: a modern view to the problem

This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis ovarian endometriomas. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometriomas on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometriomas. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease.

Preventive therapeutic options for postoperative recurrence of ovarian endometrioma: gonadotropin-releasing hormone agonist with or without levonorgestrel intrauterine system insertion.

Here, we compared endometrioma recurrence rates in patients who have undergone a laparoscopic cystectomy and treated with a gonadotropin-releasing hormone agonist (GnRHa) alone or a GnRHa combined with a levonogestrel intrauterine system (LND-IUS). We enrolled endometrioma patients who underwent laparoscopic cyst enucleation and divided them into two groups according to postoperative management: GnRHa alone and GnRHa in combination with LND-IUS. We compared preoperative history, perioperative parameters, postoperative endometrioma recurrence, and symptoms between these two groups. A total of 320 patients were included in the final analysis. With a median 84.6months of follow-up, we detected significant differences between the two groups with respect to age at surgery (31.6 ± 4.8 vs. 37.6 ± 4.2years, χ2 = 1.978, p < 0.001), gravida (0 vs. 2, χ2 = 4.391, p < 0.001), parity (0 vs. 1, χ2 = 0.035, p < 0.001), body mass index (21.0 ± 2.5 vs. 21.9 ± 2.4, χ2 = 0.0096, p = 0.009), r-AFS score (48 vs. 64, χ2 = 4.888, p = 0.001), and operation time (60 vs. 75min, χ2 = 9.119, p = 0.003). Patients treated with both GnRHa and LND-IUS achieved significantly less endometrioma recurrence (23.6 vs. 11.5%, χ2 = 5.202, p = 0.023) and higher rates of pain remission (92.1 vs. 100%, χ2 = 6.511, p = 0.011), while those with GnRHa alone suffered more recurrent and painful symptoms (χ2 = 9.280, p = 0.026). Multivariate analysis using a Cox regression demonstrated that combined GnRHa and LNG-IUS treatment correlated with a decreased endometrioma recurrence rate after laparoscopic cystectomy (RR 0.369, 95% CI 0.182-0.749, p = 0.006). Combination treatment of GnRHa and LNG-IUS exhibited superior pain relief and recurrence prevention among endometrioma patients after fertility-sparing surgery. Thus, combination treatment is a preferable long-term option for patients without intent for pregnancy in the near future.

Proposal of the 3O (Obstruction, Ureteric Orifice, and Outcome) Subclassification System Associated with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA).

To propose a "3O" (obstruction, ureteric orifice, and outcome) subclassification system associated with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). Retrospective case series. Xiangya Hospital, Central South University, Changsha, Hunan, China. A total of 26 women with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) over a 9-year period. Not applicable. In all cases, the obstruction, ureteric orifice, outcome and surgical strategy were reviewed. In our study, the "obstruction" category included 14 cases of blind hemivagina, 8 cases of buttonhole septum, 3 cases of cervical fistula, and 1 case of cervical atresia. A total of 25 patients with vaginal obstruction underwent resection of the vaginal septum. The patient with cervical atresia underwent a failed cervicoplasty, followed by hemi-hysterectomy. The "ureteric orifice" category included 24 cases of absent ureter with no orifice, as well as 2 cases of ureteric orifice emptying into the obstructed hemivagina. The 2 patients were treated with laparoscopic extirpation of the ectopic ureter and renal moiety. Regarding the "outcome" category, 5 patients with severe recurrent hematometra, hematosalpinx, and ovarian endometrioma underwent hemi-hysterectomy, salpingectomy, and cystectomy of the ovarian endometrioma. Both patients (1 with a septate uterus and 1 with a bicornuate uterus) who experienced recurrent abortion accepted uterine correction. We provide new insights into the anatomical variants of this rare syndrome with the relevant surgical implications. Magnetic resonance imaging is the most useful tool in 3O diagnosis.

1355 To Evaluate the Difference of the Efficacy of Usual Cyclic Low-Dose Monophasic Oral Contraceptive (OC) Versus Dienogest (DNG) Hormonal Therapy in the Recurrence of after Laparoscopic Excision of Ovarian Endometrioma

Study Objective To evaluate the efficacy of usual cyclic low-dose monophasic oral contraceptive (OC) use versus dienogest (DNG) in the recurrence of endometrioma after surgery. Design Retrospectively reviewed. Setting 155 patients aged from 20 years old to 40 years old who underwent laparoscopic excision of ovarian endometriomas in the department of obstetrics and gynecology of Toho University sakura medical center between April 2009 and March 2015. Patients or Participants All patients were reproductive-aged women with regular menstruation and did not want to get pregnant promptly after surgery. Interventions In the presence of endometrioma, cystectomy was performed and resection of all visible endometriosis was performed with the use of standard laparoscopic equipment. Following surgery, patients chose to receive OC, DNG for 1 year or no medication. The patients were evaluated at 3-month intervals during the following years after surgery. The recurrence rate was observed at 36 months postoperatively. Measurements and Main Results A significant reduction in recurrence rate was evident in OC and DNG users versus nonusers at 36 months postoperatively. Postoperative DNG use dramatically decreased the risk of ovarian endometrioma recurrence. Overall, there were no differences between the no recurrence and recurrence groups in terms of age, BMI, or tumor size. It was also noted that most of the OC user recurrent endometriomas were bilateral, multilocular, associated with DIE and stage IV by rASRM classification. Conclusion A significant reduction in recurrence rate was evident in OC and DNG users postoperative hormonal therapy. The stage and severity of endometriosis was significant higher in OC user recurrence group. Therefore, DNG therapy is the best option for prevention of recurrence.

Sonographic Assessment of Ovarian Endometrioma Recurrence Six Months After Laparoscopic Cystectomy in Patients with Endometriosis

Background: The high risk of recurrence of ovarian endometrioma after laparoscopy is a major challenge. Objectives: In this study, we measured recurrence of endometriosis six months after laparoscopic surgery and evaluated its risk factors in these patients. Methods: In this cross-sectional study, patients with endometrioma (based on the pathologic report) who underwent laparoscopic cystectomy in Rasool-Akram Hospital, Tehran, from April 2015 to August 2016, were evaluated by ultrasonography six months after the surgery. Endometriosis surgery was done by a team of expert surgeons. The demographic information of patients, number, size, and location of cysts, disease stage, and medical treatment taken after the surgery were recorded in the study checklist. The pre-operative endometriosis-related symptoms, including pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and dysuria were recorded by visual analogue scale and compared with related symptoms six months after the surgery. Results: Seventy-nine patients completed the study with the mean age of 31.38 ± 5.98 years. The mean cysts’ size was 69.2 ± 2.76 mm: 44.3% had multiple cysts and 39.2% bilateral endometrioma. In 53.1% deep infiltrative endometriosis (DIE) was recorded. After six months, 13.9% had a recurrence with the mean size of 37.2 ± 13.3 mm. There was a statistically significant correlation between recurrence and a previous surgery (P = 0.001) and infertility (P = 0.02). All endometriosis-related symptoms significantly decreased six months after the surgery. Conclusions: The recurrence rate, compared to the previous report, indicated that patients with a previous surgery and infertility should be closely monitored for the risk of recurrence. Possibly, damages in the previous surgery and cellular and molecular abnormalities that encountered more deeply in endometriosis-associated infertility predispose the patients to more recurrence rate, which can be further investigated.

Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women

ObjectiveTo explore the risk factors for the recurrence of endometrioma and the risk factors for the recurrence of endometriosis-related pain after long-term follow-up.MethodsThis study retrospectively analyzed 358 women with endometriomas who had a minimum of 5-years follow up after laparoscopic endometrioma excision, which was performed at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into recurrence group and nonrecurrence group. Analysis was performed with regard to preoperative history, laboratory analysis, findings during surgery, and symptoms during follow-up, including improvement and recurrence.ResultsThe cumulative incidence rates of recurrence from 5 to 10 years after surgery were 15.4, 16.8, 19.3, 22.5, 22.5, and 22.5%, respectively. Significant differences were found between two groups in terms of age at surgery (RR: 0.764, 95% CI: 0.615–0.949, p = 0.015), duration of dysmenorrhea (RR: 1.120, 95% CI: 1.054–1.190, p < 0.001), presence of adenomyosis (RR: 1.629, 95% CI: 1.008–2.630, p = 0.046), CA125 level (RR: 1.856, 95% CI: 1.072–3.214, p = 0.021) and severity of dysmenorrhea. The severity of dysmenorrhea (RR: 1.711, 95% CI: 1.175–2.493, p = 0.005) and postoperative pregnancy (RR: 0.649, 95% CI: 0.460–0.914, p = 0.013) were significantly correlated with endometrioma recurrence in the multivariate analysis. No significant associations were found between the recurrence rate and gravida, parity, body mass index, infertility, leiomyoma presence, the size of ovarian endometrioma, the presence of deep infiltrating endometriosis, disease stage or postoperative medication.ConclusionsThe severity of dysmenorrhea and postoperative pregnancy were independent risk factors for the recurrence of ovarian endometriomas after surgery during the long-time follow up.

Comparison of long-term use of combined oral contraceptive after gonadotropin-releasing hormone agonist plus add-back therapy versus dienogest to prevent recurrence of ovarian endometrioma after surgery

ObjectiveThe aim of this study was to compare long-term use of combined oral contraceptive (COC) after gonadotropin-releasing hormone (GnRH) agonist plus add-back therapy with dienogest (DNG) treatment as medical treatments after surgery for ovarian endometrioma. MethodsThis prospective cohort study analyzed 52 reproductive-aged women who underwent surgery for ovarian endometrioma and received postoperative medical treatment with either COC after GnRH agonist (n = 20) or DNG (n = 32) for 24 months. Changes in quality-of-life (QOL) and bone mineral density (BMD) were compared according to treatment. In addition, recurrence of pain and lesions were compared. ResultsBaseline characteristics did not differ in demographic profiles and factors associated with endometriosis or QOL. During 24 months of treatment, no differences in any component of QOL were found between the two groups. BMD at the lumbar spine significantly decreased after the first 6 months of treatment in both COC after GnRH agonist (−3.5%) and DNG (−2.3%) groups, but the groups did not differ statistically. After 6 months, further decrease in BMD was not observed until 24 months in both groups. In addition, no cases of pain or endometrioma recurrence were found. ConclusionOur results suggest that long-term use of COC after GnRH agonist plus add-back therapy is comparable to dienogest as a long-term postoperative medical treatment for endometriosis.

Risk factors related to the recurrence of endometrioma in patients with long-term postoperative medical therapy.

The purpose of this study was to identify clinical risk factors for the recurrence of ovarian endometrioma after ovarian cystectomy in Korean women with long-term postoperative medical therapy. A total of 134 patients who were surgically treated for endometriotic cysts at Pusan National University Hospital were included in this retrospective study. All patients received long-term postoperative medical treatment for at least 12 months after the first-line conservative surgery. Several epidemiologic variables were analyzed as possible risk factors for recurrence. Endometrioma recurrence was considered when a cystic mass was observed on transvaginal or transrectal sonography. Statistical analysis was performed using independent t-tests for parametric continuous variables. The mean follow-up period for the 134 patients was 56.5 ± 14.3 months (range, 36-120 months) and the mean duration of the medical therapy was 17.9 ± 17.3 months (range, 12-120 months). The overall recurrence rate was 35/134 (26.12%). Our univariate analysis showed statistically significant differences between the recurrent and non-recurrent groups in terms of weight (P = 0.013), body mass index (P = 0.007), age at the time of surgery (P = 0.013), the diameter of the largest cyst (P = 0.001), the presence of dysmenorrhea (P < 0.0001), and postoperative pregnancy (P = 0.016). Multivariate analysis showed that body mass index (OR 1.153, 95% CI 1.003-1.326, P = 0.046), age at the time of surgery (OR 0.924, 95% CI 0.860-0.992, P = 0.029), and presence of dysmenorrhea (OR 12.226, 95% CI 3.543-42.188, P < 0.0001) were significantly correlated with the recurrence of endometrioma. We found that patients with dysmenorrhea after surgery, and a younger age of the patient at the time of surgery were the highest risk factors associated with the recurrence of endometrioma, despite long-term postoperative medication.

Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes.

Purpose To evaluate the effectiveness of catheter-directed sclerotherapy (CDS) with 95% ethanol in patients with primary or recurrent ovarian endometriomas. Materials and Methods In this prospective study, 14 participants (mean age, 32 years; range, 20-44 years) who underwent CDS for ovarian endometrioma from March 2015 to December 2017 were evaluated. Diagnosis was based on symptoms and imaging studies. To assess the impact of CDS on ovarian reserve, serum anti-Müllerian hormone (AMH) was measured before CDS and 6 months after CDS. Serum cancer antigen 125 (CA-125) levels were also measured at the same time points. Follow-up US was performed 1, 3, and 6 months after CDS and biannually thereafter to monitor potential cyst size change and recurrence. Comparison of AMH, CA-125, and cyst size before and after CDS was performed by using the paired t test or Wilcoxon signed-rank test. Results Mean endometrioma size decreased from 5.8 cm ± 2.2 to 1.1 cm ± 1 (P ˂ .001). During a mean follow-up of 12.7 months (range, 6.1-23.0 months), there were no recurrences of endometrioma. Pain was relieved in all participants, with a decrease in serum CA-125 level (P = .001). There was no difference in serum AMH level before and 6 months after CDS, indicating well-preserved ovarian function (4.29 ng/mL ± 2.47 vs 4.36 ng/mL ± 1.94, respectively; P > .875). There were no procedure-related complications. Conclusion Catheter-based sclerotherapy with 95% ethanol can lead to better short-term clinical outcomes and well-preserved ovarian function for patients with endometriomas. © RSNA, 2018.