Treatment Of Severe Endometriosis Research Articles

Ultrasonographic 3D Evaluation in the Diagnosis of Bladder Endometriosis: A Prospective Comparative Diagnostic Accuracy Study

Objective: The use of three-dimensional (3D) transvaginal ultrasonography (TVS) has been investigated for the diagnosis of deep endometriosis (DE). This study aimed to evaluate if 3D reconstructions improve the performance of TVS) in assessing the presence and characteristics of bladder endometriosis (BE). Design: This was a single-center comparative diagnostic accuracy study. Participants/Materials, Setting, Methods: Patients referred to our institution (Piazza della Vittoria 14 Srl, Genova, Italy) with clinical suspicion of DE were included. In case of surgery, women underwent systematic preoperative ultrasonographic imaging; an experienced sonographer performed a conventional TVS; another experienced sonographer, blinded to results of the previous exam, performed TVS, with the addition of 3D modality. The presence and characteristics of BE nodules were described in accord with International DE Analysis group consensus. Ultrasound data were compared with surgical and histological results. Results: Overall, BE was intraoperatively found in 34 out of 194 women who underwent surgery for DE (17.5%; 95% confidence interval: 12.8–23.5%). TVS without and with 3D reconstructions were able to detect endometriotic BE in 82.2% (n = 28/34) and 85.3% (n = 29/34) of the cases (p = 0.125). Both the exams similarly estimated the largest diameter of BE (p = 0.652) and the distance between the endometriotic nodule and the closest ureteral meatus (p = 0.341). However, TVS with 3D reconstructions was more precise in estimating the volume of BE (p = 0.031). In one case (2.9%), TVS without and with 3D reconstructions detected the infiltration of the intramural ureter, which was confirmed at surgery and required laparoscopic ureterovesical reimplantation. Limitations: The extensive experience of the gynecologists performing the ultrasonographic scans, the lack of prestudy power analysis, and the population selected, which may have been influenced by the position of the institution as a referral center specialized in the treatment of severe endometriosis, are limitations of the current study. Conclusion: Our results demonstrated the high accuracy of ultrasound for diagnosing BE. The addition of 3D reconstructions does not improve the performance of TVS in diagnosing the presence and characteristics of BE. However, the volume of BE may be more precisely assessed by 3D ultrasound.

Clinical Study of NK Cells in the Treatment of Severe Endometriosis

Clinical Study of NK Cells in the Treatment of Severe Endometriosis

The Efficacy of Synthetic Oral Progestin Pills in Patients with Severe Endometriosis

Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.

Long-Term Outcomes in Robotic Compared With Conventional Laparoscopy for the Treatment of Severe Endometriosis

Long-Term Outcomes in Robotic Compared With Conventional Laparoscopy for the Treatment of Severe Endometriosis

Single-Port Laparoscopic Surgery in Extensive Peritoneal and Ovarian Endometriosis

Objective: The aim of this study was to assess the feasibility and safety of Single-Port Access (SPA) Laparoscopic Complete Excision (LCE) in severe endometriosis of the adnexa and pelvic peritoneum. Methods: The surgical outcomes of 40 consecutive patients that underwent SPA-LCE were compared with those from the control group with conventional LCE. Results: The mean operating time was 102 min for the SPA group and 103.4 min for the conventional group, respectively (P=0.899). Both groups had the same estimated blood loss (50 mL). The mean postoperative hospital stay of the SPA group was 1.9 days and shorter than that for the conventional group (2.8 days, P=0.008). The mean postoperative pain score after 48-hours of the SPA group was lower as compared to that of theconventional group (1.9 vs. 2.8, P=0.001). There was no operative complication in either group. Conclusion: SPA-LCE was feasible as a minimal invasive surgery for the treatment of severe endometriosis of the adnexa and pelvic peritoneum.

The management of stage III and IV endometriosis

The clinical manifestations of severe endometriosis are variable and unpredictable in both presentation and course. There are also a proportion of women with severe endometriosis who remain asymptomatic. The treatment of severe endometriosis must be individualised, taking into account the impact of the disease and treatment on pain, fertility and quality of life. Surgery is usually required and multiple organs are sometimes involved. Therefore, if endometriosis is severe, referral to a center with the expertise to offer all available treatments in a multidisciplinary team, including advanced laparoscopic surgery and laparotomy, is strongly recommended. It is also important to involve the woman in all decisions, to be flexible in diagnostic and therapeutic thinking, to maintain a good relationship with the woman and to seek advice where appropriate.

Endoscopic Technologies for Research, Diagnosis and Treatment of Severe Endometriosis

Endoscopic Technologies for Research, Diagnosis and Treatment of Severe Endometriosis

Moving towards a new year

Moving towards a new year

Aromatase Inhibitors in the Treatment of Severe Endometriosis

Endometriosis-associated chronic pelvic pain unresponsive to surgical menopause is a difficult clinical problem. A middle-aged woman presented with endometriosis and severe pelvic pain after hysterectomy and bilateral salpingo-oopherectomy. She was first treated with exemestane without improvement of symptoms. However, another aromatase inhibitor, letrozole, relieved her pain, and concomitant treatment with estrogen relieved hot flushes without pain reactivation. Letrozole was superior to exemestane in relieving the endometriosis-associated pain in this postmenopausal woman. This suggests that patients may respond variably to different aromatase inhibitors.

Anastrozole added to goserelin for post-surgical treatment of severe endometriosis reduced the risk of recurrence

Anastrozole added to goserelin for post-surgical treatment of severe endometriosis reduced the risk of recurrence

Treatment of severe endometriosis with a selective estrogen receptor modulator

Treatment of severe endometriosis with a selective estrogen receptor modulator

Treatment of severe endometriosis with a selective estrogen receptor modulator

A case of intractable endometriosis treated with raloxifene is presented. A 30 y.o. gravida 0 with infertility presented with worsening pelvic pain, hematuria, cyclic bleeding and pain from the umbilicus. Pelvic examination revealed a non-mobile, tender uterus and adnexa. Ultrasound confirmed normal ovaries but revealed a 2 cm bladder floor nodule. Cystoscopy confirmed an extrinsic bladder-wall lesion for which she underwent a trans-urethral resection. Pathology returned a diagnosis of endometriosis. The patient was placed on depot leuprolide during the postoperative bladder drainage and healing period and beyond. During the 6 months of leuprolide treatment, the patient complained of severe hot flashes, somewhat ameliorated by addition of low dose estrogen starting in the fourth month, nausea, mood lability and constant spotting. An endometrial biopsy was benign. With continuing pelvic pain, she refused further medical therapy.

Prospective randomized study comparing the GnRH-agonist leuprorelin acetate and the gestagen lynestrenol in the treatment of severe endometriosis

Endometriosis is thought to be an ovarian-dependent benign disease that affects up to 12% of women during their reproductive life. For the past ten years the gonadotropin-releasing hormone (GnRH)-agonists have been proved effective and safe drugs in the treatment of endometriosis. Nevertheless ,gestagens such as lynestrenol still remain the most often used hormonal drugs for the treatment of this disease. The primary objective of this study was to compare the efficacy of the GnRH-agonist leuprorelin acetate depot (LAD) (Enantone®-Gyn) 3.75 mg subcutaneously per month with that of the gestagen lynestrenol (LYN) (Orgametril®) 5 mg orally twice per day in women with severe endometriosis ,in terms of postoperative revised American Fertility Society (r-AFS) scores I-IV at first-look laparoscopy (score after removal of endometriotic lesions or adhesions) to the r-AFS score after six months' treatment. Secondary objectives were the improvement of clinical symptoms and the side-effect profile. Forty-eight women with postoperative r-AFS scores I-IV were evaluated in an open prospective randomized study between 1996 and 1998. All the participants underwent a first-look laparoscopy with resection of endometriotic lesions and six months' therapy with one of the above mentioned drugs ,and a further second-look laparoscopy. The six months' treatment with LAD or LYN led to a significant reduction of the r-AFS score points in both groups. The mean r-AFS score in points for the LAD group after the first-look laparoscopy was 21.8 and was 27.2 for the LYN group. After the medical treatment a mean value of 11.5 points was observed in the LAD group compared with a mean value of 25.5 in the LYN group. This difference was statistically significant (p = 0.000014 ,Wilcoxon test). The improvement in the symptoms of dysmenorrhea ,chronic pelvic pain and dyspareunia was also more pronounced in the LAD-treated group. LAD was more effective than LYN in the suppression of circulating serum 17β-estradiol levels after 6 months of treatment (mean 27.7 ± 9.3 pg/ml versus 42.6 ± 59.3 pg/ml). All the observed side-effects were deemed tolerable by the women who participated in this study. As the reduction of the r-AFS score in points was much more pronounced in the LAD group than in the LYN group ,GnRH-agonists should therefore be used as first-choice drugs in the treatment of endometriosis. Due to the limited treatment of 6 months' duration of GnRHagonists ,gestagens might be used as second-line drugs for long-term and continuous treatment in the management of endometriosis to maintain the primary beneficial effect of GnRH-agonist treatment in patients who have completed their families.

Prospective randomized study comparing the GnRH-agonist leuprorelin acetate and the gestagen lynestrenol in the treatment of severe endometriosis

Endometriosis is thought to be an ovarian-dependent benign disease that affects up to 12% of women during their reproductive life. For the past ten years the gonadotropin-releasing hormone (GnRH)-agonistshave been proved effective and safe drugs in the treatment of endometriosis.Nevertheless ,gestagens such as lynestrenol still remain the most often used hormonal drugs for the treatment of this disease.The primary objective of this study was to compare the efficacy of the GnRH-agonist leuprorelin acetate depot (LAD) (Enantone®-Gyn) 3.75 mg subcutaneously per month with that of the gestagenlynestrenol (LYN) (Orgametril®) 5 mg orally twice per day in women with severe endometriosis ,in terms of postoperative revised American Fertility Society (r-AFS) scores I-IV at first-looklaparoscopy (score after removal of endometriotic lesions or adhesions) to the r-AFS score after six months' treatment. Secondary objectives were the improvement of clinical symptoms and the side-effectprofile.Forty-eight women with postoperative r-AFS scores I-IV were evaluated in an open prospective randomized study between 1996 and 1998. All the participants underwent a first-look laparoscopywith resection of endometriotic lesions and six months' therapy with one of the above mentioned drugs ,and a further second-look laparoscopy.The six months' treatment with LAD or LYN led to a significantreduction of the r-AFS score points in both groups. The mean r-AFS score in points for the LAD group after the first-look laparoscopy was 21.8 and was 27.2 for the LYN group. After the medical treatmenta mean value of 11.5 points was observed in the LAD group compared with a mean value of 25.5 in the LYN group. This difference was statistically significant (p = 0.000014 ,Wilcoxon test). The improvementin the symptoms of dysmenorrhea ,chronic pelvic pain and dyspareunia was also more pronounced in the LAD-treated group. LAD was more effective than LYN in the suppression of circulating serum 17β-estradiollevels after 6 months of treatment (mean 27.7 ± 9.3 pg/ml versus 42.6 ± 59.3 pg/ml). All the observed side-effects were deemed tolerable by the women who participated in this study. As thereduction of the r-AFS score in points was much more pronounced in the LAD group than in the LYN group ,GnRH-agonists should therefore be used as first-choice drugs in the treatment of endometriosis. Dueto the limited treatment of 6 months' duration of GnRHagonists ,gestagens might be used as second-line drugs for long-term and continuous treatment in the management of endometriosis to maintain the primarybeneficial effect of GnRH-agonist treatment in patients who have completed their families.

Treatment of severe endometriosis with an aromatase inhibitor: A novel indication and its molecular basis

Treatment of severe endometriosis with an aromatase inhibitor: A novel indication and its molecular basis

Combined use of a long-acting gonadotropin-releasing hormone agonist and low-dose danazol in advanced stage endometriosis

In this preliminary study, the safety and efficacy of a combined GnRHa and low-dose danazol regimen was evaluated in patients with advanced stage endometriosis. Five patients with stage IV endometriosis were administered triptorelin 3.75 mg intramuscularly with monthly intervals in combination with oral danazol 100 mg/day for 6 months. Laparoscopy was performed before and after therapy to assess the change in endometriotic lesions. During controls, patients were evaluated for the change in hormonal and biochemical parameters and the side effects of the treatment. In 4 patients with ovarian endometriomas, cysts were drained during initial laparoscopy. None of the endometriomas persisted after therapy. Total scores, according to the revised American Fertility Society classification of endometriosis were, 54.8 ± 10.9 before treatment and decreased to 31.6 ± 10.3 ( P < 0.05), whereas, endometriotic implants scores changed from an initial value of 22.8 ± 12.1 to 1.2 ± 1.1 ( P < 0.05). No adverse effect was observed on lipid and liver metabolism. Estrogen deprivation symptoms and oily skin were the most prominent complaints and one patient had a weight gain of 6 kg. Based on these results we conclude that a combination of GnRHa and low dose danazol is an effective alternative treatment modality in the treatment of severe endometriosis without any serious side effect.

Laparoscopic treatment of severe endometriosis

Between March 1994 and November 1995 I performed 54 laparoscopic procedures for chronic pelvic pain. Severe (grade 4) endometriosis was found in nine women. Operating time in these women ranged from 90 to 210 minutes and the average hospital stay was 24 hours. The only complication was a colonic-vaginal fistula. I believe that this endoscopic technique can be successful in treating severe endometriosis if the surgeon has experience in both laparoscopic and bowel surgery.