Treatment Of Rectovaginal Endometriosis Research Articles

Treatment of rectovaginal endometriosis with the etonogestrel-releasing contraceptive implant

This study aimed to investigate the efficacy of the etonogestrel (ENG)-releasing implant in treating patients with rectovaginal endometriosis. The study was based on the retrospective analysis of a prospectively collected database, including symptomatic women who had ultrasonographic diagnosis of rectovaginal endometriosis. Patients were follow-up at 6, 12 and 24 months from the insertion of the ENG-releasing implant. The intensity of pain symptoms was evaluated using a visual analog scale. The volume of the nodules was estimated by virtual organ computer-aided analysis. The Endometriosis Health Profile (EHP-30) was used to evaluate quality of life. Overall, 43 women were included in the study. The 2-year continuation rate for the ENG-releasing implant was 93.0%. The treatment quickly improved the intensity of non-menstrual pelvic pain, deep dyspareunia, dysmenorrhea, and dyschezia. At 6-month follow-up, there were improvements in all domains of the EHP-30 compared with baseline. Further improvements in the EHP-30 results were observed only in pain sub score at 12-month follow-up and in emotional well-being sub score at 24-month follow-up. At 6-month follow-up the volume of the rectovaginal nodules was significantly lower compared with baseline; a further decrease was observed at 12- and 24-month follow-up. The treatment was well tolerated.

The Role of Shaving Technique in the Treatment of Recto-Vaginal Endometriosis

Video Objective To demonstrate the rational use of shaving technique in the approach of endometriotic lesions of the recto-vaginal septum in selected cases. Setting Botucatu Medical School, Sao Paulo State University - FMB/UNESP. Tertiary public hospital, university teaching center. Interventions The procedure begins by characterizing the endometriotic lesion, by recognition of the pelvic anatomical structures and their relations with the disease. The physiological adherence of the sigmoid to the left pelvic wall is dissected, followed by identification of the ureters. Anatomic markers are used to guide dissection avoiding complications and inadvertent injury of noble structures. The retroperitoneal dissection begins on both sides from healthy tissue laterally towards the medial retro-uterine portion until it reaches the central portion of the lesion in the insertion of uterosacral ligaments. From this point on, the lesion is confined to the posterior portion of the uterus and anterior wall of the rectum. The endometriotic lesion is then isolated in the rectal wall using the reverse shaving technique. With the aid of a rectal probe, superficial resection of the endometriotic lesion is started, taking care not to deepen its dissection beyond the superficial sero-muscular layer. Finally, rigorous hemostasis is performed. When resection is very deep or very extensive it is advisable to check the integrity of the rectum-sigmoid wall with the aid of safety maneuvers. The vaginal touch is repeated at the end of the procedure to confirm that the entire initial lesion has been removed. Conclusion Despite its indication only for cases of superficial lesions the shaving technique presents as advantages: autonomy for the gynecologist, less tissue damage with preservation of the neuronal activity of the intestine, rapid recovery with early return of the daily life activity to the patient, being a great option for the treatment of rectum-vaginal endometriosis in duly selected cases.

Vaginally Administered Danazol: An Overlooked Option in the Treatment of Rectovaginal Endometriosis?

Danazol has been used in the treatment of endometriosis and heavy menstrual bleeding for more than 40 years. This medication has both central antigonadotropic actions and direct atrophic effects on endometriotic tissue. Although it demonstrates a high-efficacy profile, the associated side effects have resulted in limited usage. Vaginal administration of the drug may prove favourable specifically in rectovaginal endometriosis. This targeted mode of delivery is associated with a significant reduction in both pain symptoms and nodule size. The relative persistence of these therapeutic benefits is likely related to the direct tissue effects after absorption through the vaginal mucosa. Vaginal administration would also limit systemic propagation of danazol and thus should minimize androgenic side effects. Use of vaginal danazol also improves heavy menstrual bleeding and may even restore fertility in some patients. In this review we provide a critical analysis of the existing literature on the use of vaginal danazol.

Dienogest in the treatment of rectovaginal endometriosis: effect on deep dyspareunia and sexual function

To investigate the efficacy of dienogest (DNG) in treating deep dyspareunia (DD) and in improving sexual function in women with rectovaginal endometriosis. Prospective open-label cohort pilot study. This study included premenopausal sexually active women with rectovaginal endometriosis suffering DD (more than 6 month duration and intensity > 80 mm on a 100 mm visual analogue scale). The diagnosis of rectovaginal endometriosis was based on vaginal and rectal examinations and it was confirmed by transvaginal ultrasonography. The criteria for exclusion from the study were: therapies for endometriosis other than non-steroidal anti-inflammatory drugs in the 3 months before inclusion in the study (6 months for GnRH analogues); unwillingness to tolerate menstrual changes; undiagnosed vaginal bleeding; obstructive uropathy or bowel stenosis and evidence of complex adnexal cysts. Eligible patients received DNG (2 mg/day) for 6 months. The primary end-point of the study was to assess the changes in DD during treatment. The secondary objective of the study was to evaluate the changes in sexual function, which was evaluated by using the Female Sexual Function Index (FSFI). Outcomes were assessed after 3 and 6 months of treatment. 23 women were included in the study; the mean (± SD) age of the study population was 34.2 (± 3.7) years. The mean (± SD) intensity of DD was 9.1 (± 0.7) cm; it significantly decreased at 3-months of treatment (7.4 ± 1.4 cm; p<0.001). At 6-month treatment the intensity of DD (6.5 ± 1.6 cm) was lower than at baseline (p<0.001) and at 3-month treatment (p<0.001). The total FSFI score was significantly higher at 3-month treatment than at baseline (p < 0.001); there was no significant difference in the total FSFI score between 3- and 6- month treatment (p = 0.188); at both 3- and 6-month treatment the mean total FSFI score remained below the threshold for sexual dysfunction. At 6-month treatment significant improvements were observed in the following subscores: lubrication (p=0.011), orgasm (p=0.010) and pain (p=0.016). In patients with severe DD caused by rectovaginal endometriosis, 6-month treatment with DNG causes a significant decrease in the intensity of this symptom that however persists with moderate intensity. Although an improvement was observed in the total FSFI score, it remained below the threshold for sexual dysfunction.

Diagnosis and treatment of rectovaginal endometriosis: an overview

Rectovaginal endometriosis can be a cause of severe pain, dyspareunia and intestinal problems. A thorough examination is needed and should include diagnostic imaging, such as transvaginal or transrectal ultrasound or magnetic resonance imaging. Medical therapies, such as oral contraceptives, progestins and levonorgestrel-releasing intrauterine devices, all seem to reduce pain and should always be considered. Surgical treatment is challenging and implies a risk of severe complications. It is preferable to treat endometriotic lesions with superficial infiltration into the rectal wall by local laparoscopic excision, while segmental rectal resection is needed in the case of severe intestinal infiltration. This review describes available diagnostic tools, the possibilities for medical treatment and the alternative surgical approaches.

Comparison between standard and reverse laparoscopic techniques for rectovaginal endometriosis

This study was designed to compare the surgical outcomes of standard and reverse laparoscopic techniques for the treatment of rectovaginal endometriosis. A retrospective study was conducted in a teaching and research hospital (tertiary center), which included 75 women subjected to laparoscopic treatment of rectovaginal endometriosis that required both vaginal resection and rectal surgery. Standard and reverse laparoscopic techniques were compared in 35 and 40 women, respectively. Student's t test, Mann-Whitney test, and Fisher's exact test were performed to compare groups when needed; p < 0.05 was considered statistically significant. There was no statistically significant difference in operating time, blood loss, conversion rate, major intraoperative complications, length of hospital stay, and minor postoperative complications between the two techniques. The rate of major postoperative complications for the standard technique was 22.9%, whereas only 5% for the reverse technique (p = 0.02). The rate of postoperative rectovaginal fistula was the same for both techniques. Major postoperative complications were reduced by using the reverse technique.

Pharmacological treatment of endometriosis: update from recent clinical trials

Endometriosis is a chronic disease that causes pain and infertility. Combined oral contraceptives and progestins are commonly used for the treatment of endometriosis because they reduce the severity of pain symptoms in 60–70% of patients and are well tolerated. Gonadotropin-releasing hormone analogs and danazol may be administered to selected patients but their long-term use is limited owing to the high frequency of severe adverse effects. Aromatase inhibitors should be administered only to women who fail to improve after surgery and conventional hormonal therapy because they are not well tolerated. This article discusses the medical therapies available for the treatment of endometriosis-related pain symptoms; in addition, detailed information on the recent advances in the treatment of rectovaginal endometriosis, ovarian endometriomas and bowel endometriosis is presented.

Quality of Sex Life after Laparoscopic Treatment of Rectovaginal Endometriosis: Results of a Pilot Study

Quality of Sex Life after Laparoscopic Treatment of Rectovaginal Endometriosis: Results of a Pilot Study

25: Surgical Treatment of Rectovaginal Endometriosis – Retrospective Results for the First 45 Patients Treated at the MATTU, Guildford, United Kingdom

25: Surgical Treatment of Rectovaginal Endometriosis – Retrospective Results for the First 45 Patients Treated at the MATTU, Guildford, United Kingdom

Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis

Objective: To evaluate the effectiveness of a levonorgestrel-releasing IUD as therapy for endometriosis of the rectovaginal septum. Design: Prospective therapeutic non-randomized, self-controlled clinical trial analyzing changes in pain symptoms and size of lesions induced by the levonorgestrel-releasing IUD over 12 months. Setting: Tertiary referral center for treatment of deep endometriosis. Patient(s): Eleven symptomatic patients with rectovaginal endometriosis. Intervention(s): A levonorgestrel-releasing IUD was inserted and maintained for 12 months. Main Outcome Measure(s): Severity of dysmenorrhea, pelvic pain, and deep dyspareunia were assessed before insertion of the IUD and throughout treatment. The size of rectovaginal endometriotic lesions were evaluated by using transrectal and transvaginal ultrasonography. Result(s): Dysmenorrhea, pelvic pain, and deep dyspareunia greatly improved and the size of the endometriotic lesions was significantly reduced by treatment. Conclusion(s): Insertion of a levonorgestrel-releasing IUD alleviates pain and reduces the size of lesions in patients with endometriosis of the rectovaginal septum.

Treatment of Rectovaginal Endometriosis

Treatment of Rectovaginal Endometriosis