History of Uterine Surgery Is Not Associated With an Increased Severity of Bladder Deep Endometriosis.

STUDY OBJECTIVE: To analyze whether a history of uterine surgery correlates with disease severity in patients with bladder deep infiltrating endometriosis (DIE). DESIGN: This was an observational, cross-sectional study using data collected prospectively (Canadian Task Force classification II-2). SETTING: A single university tertiary referral center. PATIENTS: We included all nonpregnant women younger than age 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient, a standardized questionnaire was completed during a face-to-face interview that was conducted by the surgeon in the month preceding the surgery. INTERVENTIONS: One hundred seven women with histologically proven bladder DIE were enrolled in this study. For the purpose of the study, the women were assigned to 2 groups before surgery: a study group that included women with a history of a scarred uterus (SU) (SU+, n = 16) and a control group that included women without SU (SU-, n = 99). Both groups were compared in terms of their general characteristics, medical histories, surgical findings, and the severity of the disease. MEASUREMENTS AND MAIN RESULTS: Patient age and body mass index were higher for the SU+ group as compared to the SU- group (37.9 ± 5.6 vs 32.2 ± 4.7, p < .01, and 24.7 ± 4.9 vs 21.9 ± 2.9, p = .03, respectively). Preoperative painful symptom scores did not differ between the 2 groups. No significant difference was observed in the rates of history for surgery for endometriosis (n = 11 [68.7%] vs n = 49 [53.8], p = .27). Comparison of the anatomic distribution of the lesions did not reveal a significant difference. The total American Society for Reproductive Medicine score did not differ between the groups (32.0 ± 34.4 vs 35.5 ± 34.5, p = .71). The incidence rate of isolated bladder DIE did not differ between the 2 study groups (n = 6 [37.5%] vs n = 40 [43.9%], p = .79). CONCLUSION: SU before surgery for endometriosis was observed in 14.9% of cases of bladder DIE; however, this was not related to an increased severity of the disease. This observational study hence does not appear to support the pathophysiologic hypothesis of a transmyometrial source for bladder DIE.

Surgical treatment: Myomectomy and hysterectomy; Endoscopy: A major advancement.

Uterine fibroids affect 25% of women worldwide. Symptomatic women can be treated by either medical or surgical treatment. Development of endoscopic surgery has widely changed the management of myoma. Currently, although laparoscopic or laparoscopic robot-assisted myomectomies or hysterectomies are common, there has been no consensual guideline concerning the surgical techniques, operative route, and usefulness of preoperative treatment. Hysteroscopy management is a major advancement avoiding invasive surgery. This study deals with a literature review concerning surgical management of fibroids.

Uterine adenosarcoma associated to lymphovascular emboli: a case report.

INTRODUCTION: Uterine adenosarcoma is a rarely observed polypoid tumor with a mixed benign epithelial element and malignant stromal component. The treatment is total hysterectomy with bilateral salpingo-oophorectomy. It could be difficult to diagnose and associated to lymphovascular invasion. CASE PRESENTATION: A 45-year-old caucasian uniparous woman presented with uterine bleeding. She had several surgical procedures and pathology of removed recurrent polyps showed no malignancy. Finally, a total abdominal hysterectomy was performed because of atypical cells and suspected uterine adenosarcoma. The hysterectomy specimen confirmed the presence of uterine adenosarcoma associated with lymphatic and vascular tumor emboli. Surgery was completed with a second bilateral salpingo-oophorectomy and pelvic lymphadenectomy. CONCLUSION: In our report, we present a case of uterine adenosarcoma which was diagnosed after multiple surgical procedures and associated to lymphovascular emboli known to have a significant impact on overall survival and distant metastasis-free survival.