Preoperative assessment of intestinal endometriosis: A comparison of transvaginal sonography with water-contrast in the rectum, transrectal sonography, and barium enema.

To evaluate the accuracy of Transrectal Sonography (TRS) and a new technique, Transvaginal Sonography with Water-Contrast in the Rectum (RWC-TVS), in the diagnosis of rectosigmoid endometriosis, and the accuracy of Barium Enema (BE) and RWC-TVS in the detection of intestinal stenosis due to endometriosis. In a prospective study, we compared the findings of TRS and RWC-TVS performed before surgery with the operative and pathologic findings in 61 consecutive patients who underwent laparoscopy or laparotomy for suspected rectosigmoid endometriosis. The accuracy of BE and RWC-TVS in the detection of intestinal stenosis was evaluated comparing the radiologic and ultrasonographic results with the macroscopic findings at surgery and pathology. RWC-TVS diagnosed rectosigmoid endometriosis with the same accuracy of TRS and was equally efficient as BE in the detection of a significant intestinal lumen stenosis. For the diagnosis of rectosigmoid endometriosis the sensitivity, specificity, positive and negative predictive values of TRS and RWC-TVS were 88.2% and 96%, 80%, and 90%, 95.7%, and 98%, and 57.1% and 81.8%, respectively. For the detection of intestinal stenosis the sensitivity, specificity, positive and negative predictive values of BE and RWC-TVS were 93.7% and 87.5%, 94.2% and 91.4%, 88.2% and 82.3%, and 97% and 94.1%, respectively. RWC-TVS is a new, simple technique for a single-step and accurate preoperative assessment of rectosigmoid endometriosis.

Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas.

BACKGROUND: Over the past decade an increasing demand for uterine-sparing treatment to manage symptomatic uterine myomas has become apparent in women's health care. A preliminary report showed that radiofrequency ablation (RFA) of uterine fibroids under laparoscopic guidance was a safe and effective minimally invasive approach with encouraging short-term results. The purpose of this study was to evaluate the midterm outcomes of radiofrequency ablation (RFA) of uterine myomas in terms of durability of symptom control and level of health-related quality of life. METHODS: Consecutive women with symptomatic uterine myomas, no plans for future pregnancy, and who declined hysterectomy were offered RFA ablation of uterine fibroids under laparoscopic guidance. Only 25 patients who completed at least the one-year follow-up assessment were included in the study group. Follow-up evaluations were scheduled at 1, 3, 6, 9, and 12 months and thereafter annually following the procedure. Improvement in myoma-related symptoms and impact on quality of life were assessed using a validated questionnaire (UFS-QOL). RESULTS: The median number of myomas treated per patient was 1 (range = 1-3). The median baseline volume of the dominant myoma was 76.8 cm3 (range = 14.8-332.8). No intraoperative or postoperative complications occurred. The median follow-up time was 24 months, with nine women completing three years of follow-up. The median reduction in myoma volume was 68.8% and 77.9% at six months and one year, respectively. No further change in fibroid size was observed at two years and three years. One year after the procedure, one woman (4%) underwent hysterectomy for recurrence of fibroid-related symptoms. Quality-of-life measures showed significant and durable improvement compared with baseline. CONCLUSIONS: RFA of symptomatic fibroids seems a valuable alternative to major surgery, with durable symptom relief for most patients and a low chance of recurrence at midterm.