1,720,974 research outputs found
Laparoscopic ovarian puncture for correct staging of endometriosis
No full textSmall, deep ovarian endometriomas are not easily diagnosed. In 52 infertile patients, laparoscopy demonstrated enlarged ovaries (maximum diameter 3.5 to 5 cm) with a smooth whitish surface and no mature follicles, corpora lutea, or other cysts. Ovarian puncture was performed, and endometriotic material aspirated in 25 women (48.0%). Cyst diameter was calculated using the geometric formula r = 3 square root of 3V/4 pi where r = radius and V = volume of liquid aspirated. Eight patients with apparently normal pelvis had endometriosis, and 14 with apparent minimal or mild endometriotic lesions were restaged. Laparoscopic ovarian puncture of enlarged ovaries was important for correct diagnosis and staging of endometriosis
Adenomyosis: fertility and obstetric outcome : a comprehensive literature review
No full textAdenomyosis is a benign condition characterized by the presence of endometrial glands and stroma deep within the myometrium. In recent years, the potential negative impact of adenomyosis on in vitro fertilization clinical outcomes has gained momentum, as well as, the possible link of this condition with obstetrical complications. The aim of this narrative review is to elucidate the possible association between uterine adenomyosis, infertility, and poor obstetrical outcomes. Several theories have been proposed to clarify the potential harmful impact of adenomyosis on fertility, such as a functional and structural defect of both the eutopic endometrium and the inner myometrium, an impairment of the uterine system of sperm transport, the presence of uterine dysperistalsis and of high levels of free radicals in the uterine milieu of women with the disease. Numerous studies have demonstrated that adenomyosis exerts a detrimental effect on in vitro fertilization outcomes, reducing pregnancy and live birth rates and increasing miscarriage rate. Regarding pregnancy outcomes data are scarce; however, epidemiological studies suggest that women with uterine adenomyosis could be at increased risk of numerous obstetrical complications, in particular, preterm birth and preterm premature rupture of membranes. These preliminary results are valuable for preconception and prenatal counseling of women with adenomyosis and suggest that this category of women necessitate a more cautious prenatal management than previously expected
The outcomes of repeat surgery for recurrent symptomatic endometriosis
No full textPurpose of review
To evaluate the efficacy of second-line surgery in the management of recurrent
endometriosis.
Recent findings
Long-term probability of pain recurrence after repeat conservative surgery for recurrent
endometriosis varies between 20 and 40%. The association of presacral neurectomy
to the treatment of endometriosis might be effective in reducing midline pain; however,
no studies have evaluated this procedure among patients with recurrent disease.
The medium-term outcome of hysterectomy for endometriosis-associated pain is quite
satisfactory; nevertheless, probability of pain persistence after hysterectomy is 15% and
risk of pain worsening 3–5%, with a six times higher risk of further surgery in
patients with ovarian preservation as compared to ovarian removal. The conception rate
among women undergoing repetitive surgery for recurrent endometriosis associated
with infertility is 26%, whereas the overall crude pregnancy rate after a primary
procedure is 41%.
Summary
Repeat conservative surgery for pelvic pain associated with recurrent endometriosis has
the same efficacy and limitations as primary surgery. Conversely, after repeat
conservative surgery for infertility, the pregnancy rate is almost half the rate obtained
after primary surgery. More data are needed to define the best therapeutic option in
women with recurrent endometriosis, in terms of pain relief, pregnancy rate and
patient compliance
Second-look laparoscopy in the treatment of endometriosis
No full textThe results of second-look laparoscopy were compared with subjective symptomatology and findings at pelvic exploration in 36 patients who had received conservative treatment for endometriosis. In the 14 patients given pharmacologic treatment, second-look laparoscopy demonstrated active endometriosis in 57.1%, whereas pelvic pain was present in 64.3% and gynecologic examination was positive in 28.6%. In the 22 patients who underwent surgery, active endometriosis was detected by second-look laparoscopy in 31.8%, whereas 40.9% reported pelvic pain and pelvic examination was positive in 31.8%. Thus clinical signs and symptoms were unreliable in the diagnosis of endometriosis recurrence, whereas laparoscopy was indispensable. It should be programmed for 6 months from the end of medical treatment and 12 months after surgery; however, if the pain symptomatology recurs, then laparoscopy is performed immediately
Communicating uteri : description and classification of a new type
No full textA case of bicornuate-bicervical communicating uterus with atresia of the right hemicervix is reported. This cannot be included in any of the nine groups of Toaff's classification of uterine malformations proposed in 1984, and should be classified as a new, tenth type
Serum CA 125 measurements in the diagnosis of endometriosis recurrence
No full textSeventy-one women underwent follow-up laparoscopy for persistent infertility six to 24 months after conservative treatment of endometriosis. The disease was staged according to the revised American Fertility Society classification of 1985. The serum CA 125 concentration was also measured in each patient to evaluate its efficacy in the diagnosis of endometriosis recurrence. The patients with stages I and II endometriosis had serum CA 125 levels not significantly higher than in the patients with negative findings, whereas those with stages III and IV endometriosis presented significantly higher levels (P less than .005 and P less than .001, respectively) than the disease-free women. The sensitivity of serum CA 125 measurements in the diagnosis of endometriosis recurrence was 14.8%, the specificity was 100%, and the predictive values of normal (less than 35 U/mL) and elevated levels were 27 and 100%, respectively. In some cases, serum CA 125 measurements may be used instead of follow-up laparoscopy, or to indicate when laparoscopy should be performed or postponed
The role of myomectomy in fertility enhancement
No full textPurpose of review: To review current available literature on the relationship between fibroids and infertility with particular emphasis on the benefits of myomectomy. Pregnancy complications related to the presence of these lesions and to their removal are also addressed.
Recent findings: There is a biological plausibility supporting a causal relationship between fibroids and infertility. From a clinical point of view, this association is mostly supported by studies comparing pregnancy rate following IVF in women with and without fibroids. The emerging view is that submucosal, intramural and subserosal fibroids interfere with fertility in decreasing order of importance. There is one randomized controlled trial supporting the benefits of myomectomy in infertile women with fibroids. The beneficial effects of surgery are further supported by insights from clinical series showing that the pregnancy rate following myomectomy is satisfactory and by the strong benefits documented in the few nonrandomized comparative studies. An increased rate of obstetric complications has been reported in women carrying fibroids. Data regarding the course of pregnancy in operated women are scanty. The most significant (although rare) complication is rupture of the uterus during pregnancy or labour.
Summary: At present, owing to the lack of adequately designed trials aimed to clearly establish that lesions benefit from surgery, a comprehensive and personalized approach should be adopted. The most important variables to be considered are the age of the woman, the characteristics of the fibroids, the concomitant presence of fibroids-related symptoms and the presence of other causes of infertility
Endometrioma of the liver
No full textHepatic endometriosis is extremely rare. We describe a patient sent to us with epigastric pain as the only symptom and who was found to have associated endometrioma of the liver and left ovary. We suggest a gynecologic evaluation before surgery for hepatic cyst of unknown cause
Pelvic endometriosis and hydroureteronephrosis
No full textObjective
To assess whether routine renal ultrasonography may be recommended in all patients with pelvic endometriosis, in order to avoid silent ureteral involvement of the disease.
Design
Retrospective descriptive study.
Settings
Tertiary center for the treatment of endometriosis at the Department of Obstetrics and Gynecology of the State University of Milan, Milan, Italy.
Patient(s)
Seven-hundred-fifty patients with a primary diagnosis of endometriosis, between January 2005 and July 2007.
Intervention(s)
Routine urinary ultrasound; recording of patient history, signs, and symptoms; gynecologic examination; blood and urinary analyses; magnetic resonance imaging; spiral multislice computerized tomography.
Main Outcome Measure(s)
Symptoms and signs of ureterohydronephrosis; diagnosis of ureterohydronephrosis.
Result(s)
Twenty-three patients (3%) of all 750 patients with endometriosis had associated ureterohydronephrosis diagnosed at renal ultrasound. Symptoms secondary to ureteral and renal involvement were present in 10 patients (43.5%); 6 reported lumbar pain (26.1%) and 4 patients (17.4%) had renal colic.
Conclusion(s)
In our study, the high number (56.5%) of asymptomatic ureteral involvement in patients with known pelvic endometriosis seems to warrant the need for further investigations regarding the possibility to avoid the high percentage of silent renal losses. Unfortunately there appears to be no specific risk factor to allow for early suspicion nor a validated preventive diagnostic and therapeutic program. It remains to be evaluated whether urinary ultrasound ensures a beneficial cost-benefit ratio if employed on a routine basis
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