[Bladder endometriosis - long-term efficacy of radical laparoscopic surgery]. / Endometrioza pecherza moczowego ­ dlugoterminowa ocena efektów radykalnego leczenia laparoskopowego.

While endometriosis affects up to 15% of the female population of childbearing potential, the involvement of the urinary system is a relatively rare occurrence. It affects only 1-2% of all patients with endometriosis. Symptoms consistent with chronic pelvic pain syndrome or dysuria, related to endometriosis, remain a challenge in both diagnostic and therapeutic terms. AIM: The aim of the study was to evaluate the long term effects of advanced laparoscopic surgery of deep infiltrating endometriosis of the bladder. MATERIALS AND METHODS: This paper is a summary of radical laparoscopic surgery results in 21 patients with urinary bladder endometriosis. The majority of cases involved primary endometriosis of the bladder, there was only one case of postoperative bladder endometriosis, that was diagnosed many years after a caesarean section. All patients underwent radical laparoscopic surgery. RESULTS: All endometriotic lesions involving the bladder wall were excised within healthy tissue margins in all patients undergoing surgery. Pathology confirmed endometriosis in all cases. Dysuria and chronic pelvic pain have completely withdrawn in all patients, and postoperative observation at the time of writing (median period of 30.7 months, range 4.1-111.2 months) revealed a consistent and durable therapeutic effect of surgery. CONCLUSIONS: Endometriosis of the urinary bladder is not a common pathology. Nevertheless, it should be taken into consideration in cases of unexplained dysuria or imaging suggestive of urinary bladder malignancy. The treatment of choice is radical laparoscopic excision of the endometriotic lesions. This modality usually ensures complete resolution of symptoms, along with a marginal risk for recurrence and minimal early and late complication rates.

[CO2 laser ablation of cervical endometrioid lesions - treatment efficacy evaluation]. / Ablacja zmian endometrialnych szyjki macicy laserem CO2 ­ ocena skutecznosci leczenia.

Endometriosis affects 10-15% of the female population of childbearing potential. Endometrioid lesions of the cervical surface are a rare manifestation of the disease. There are various complaints related to this particular form of endometriosis, making the diagnosis challenging. Treatment also raises problems, as widely available and used therapeutic methods often prove to be ineffective. AIM: The aim of the study was to evaluate the efficacy of CO2 laser beam ablation in a group of patients with cervical endometriosis lesions. MATERIALS AND METHODS: This paper presents a summary of cervical endometriosis treatment efficacy in a group of 15 patients who have undergone CO2 laser ablation between May 2016 and April 2019. The majority of patients have already been treated for cervical endometriosis, using cryotherapy, electrocoagulation, curettage and loop electrosurgical excision procedure (LEEP). All patients, following preliminary colposcopy verification and exclusion of malignancies, have undergone CO2 laser ablation of endometrioid cervical lesions. A visual evaluation of the cervix was performed before treatment, directly after the procedure, as well as 4-6 weeks after the procedure, and subsequently every 6-8 months. RESULTS: This paper presents a summary of cervical endometriosis treatment efficacy in a group of 15 patients who have undergone CO2 laser ablation between May 2016 and April 2019. The majority of patients have already been treated for cervical endometriosis, using cryotherapy, electrocoagulation, curettage and loop electrosurgical excision procedure (LEEP). All patients, following preliminary colposcopy verification and exclusion of malignancies, have undergone CO2 laser ablation of endometrioid cervical lesions. A visual evaluation of the cervix was performed before treatment, directly after the procedure, as well as 4-6 weeks after the procedure, and subsequently every 6-8 months. CONCLUSIONS: Cervical endometriosis is a rare manifestation of the diseases, with variable symptoms. It can become a diagnostic challenge, as endometrioid lesions may be confused with cervical malignancies, as well as a therapeutic one, as many of the methods employed prove unsuccessful. Laser ablation of endometrioid cervical lesions seen to be a minimally invasive, safe and effective treatment method that can be offered in an outpatient setting.

[Fertility outcomes following radical conservative laparoscopic endometriosis surgery in infertile patients]. / Wyniki radykalnego zachowawczego leczenia operacyjnego endometriozy u chorych z nieplodnoscia.

Endometriosis affects 6%-15% of the female population of childbearing potential. Endometriosis has a wide range of symptoms. Infertility is one of the major and common consequences of endometriosis. Many treatment options are offered to the infertile patient - pharmacotherapy, dietary treatment, Assisted Reproductive Technology (ART), and surgery. Medical and dietary treatment alleviate symptoms, without improvement in pregnancy rates. Limited value of surgery is sometimes advocated, suggesting only ART improve pregnancy rates. AIM: The aim of the study was to analyze the effectiveness of the surgical treatment of patients with endometriosis and infertility expressed in the number of pregnancies and the births. MATERIALS AND METHODS: The basis for the analysis was the prospectively updated database of patients with endometriosis undergoing surgical treatment, which included 768 records as of May 30, 2019. The analysis selected the period from 01/01/2013 to 31/12/2016, which treated 164 patients with endometriosis and sterility. 139 patients were qualified for the analysis. Most of the previously analyzed were treated for endometriosis and infertility (pharmacotherapy, surgery, ART-Assisted Reproductive Technology). All patients underwent standardized surgical treatment developed by the authors - radical conservative laparoscopic surgery. The analysis of pregnancies was performed for all patients jointly and according to the division according to the severity of the disease, including the methods of pregnancy (spontaneous pregnancy, ART). The analyzed group was divided according to the stage of endometriosis (IV - 40.3%, III - 21.6%, II - 26.6%, I - 11.5%), the majority being patients with symptoms of severe endometriosis (III + IV = 61.9%). Values of nominal variables were compared between groups with the chi-square test, and the Kruskal-Wallis test was used for measurable variables. As a statistical significance threshold, p <0.05 was accepted. RESULTS: By May 2019, a total of 130 pregnancies in 101 cases were registered. There were 35 abortions, 95 live births (including 7 premature births) and 2 ongoing pregnancies. The percentage of pregnancies in the study group was 72.66%. CONCLUSIONS: Pregnancy rate of 72.66% in the whole group and 70.93% in the group of advanced endometriosis is an encouraging and indicative result of radical conservative laparoscopic surgical treatment of endometriosis in patients with infertility.

[Isolated vesical endometriosis - a case report].

INTRODUCTION: Although endometriosis affects up to 15% of the female population with childbearing potential, isolated endometriosis of the urinary tract is not a frequent occurrence, as it involves only 1 to 2% of all endometriosis patients. The chronic pelvic pain syndrome ultimately related to endometriosis is often both a diagnostic and therapeutic challenge Materials and methods: This paper presents the case of a female patient reporting with severe urinary symptoms. Following cystoscopy and ultrasonography investigations, a suspected endometrioid lesion of the urinary bladder has been evidenced. The patient-reported pain was rated using a 10-point visual analogue scale (VAS). The patient has not received pharmacotherapy. RESULTS: A partial laparoscopic full-thickness excision of the urinary bladder wall with the evidenced lesion has been performed. The urinary bladder wall has been sutured using two layers of sutures applied by laparoscopy. Postoperative histopathology examination revealed a deep infiltrating endometriosis lesion of the urinary bladder wall. Following surgery, the patient's complaints have withdrawn completely, and no subsequent pharmacotherapy was instated. DISCUSSION AND CONCLUSIONS: Isolated endometriosis of the urinary tract, including the urinary bladder, is not a common pathology. Nevertheless, it should always be taken into account in patients with dysuria or symptoms suggestive of bladder malignancy. Total laparoscopic excision of the lesion remains the treatment of choice, and in most cases provides patients with complete withdrawal of symptoms, and only minimal incidence of recurrences, as well as limited risk of early and delayed complications.

Determination of Serum Arginase-1 Concentrations and Serum Arginase Activity for the Non-Invasive Diagnosis of Endometriosis.

Backgroud: Endometriosis remains a diagnostic challenge, both clinically and economically, affecting 6% to 15% of women of child-bearing potential. We have attempted to determine whether testing serum concentrations and activity of arginase isoenzymes could be useful for the non-invasive diagnosis of endometriosis. Methods: This study involved 180 women (105 endometriosis subjects-study group B; 22 subjects with other benign gynaecological conditions-control group 1-K1, both undergoing surgery; and 53 healthy subjects without features of endometriosis-control group 2-K2). Results: Preoperative and postoperative arginase-1 (Arg-1) concentrations were significantly higher in patients, as compared with the control groups K1 (p < 0.0001 and p = 0.0005, respectively) and K2 (both p < 0.0001). Similarly, arginase activity was significantly higher in patients than in the control group K1 before surgery and higher than in both control groups after surgery. No significant differences in either Arg-1 concentrations or arginase activity were noted between the operated control group K1 and the non-operated control group K2. A significant postoperative decrease in Arg-1 concentration was observed within both patient (p < 0.0001) and control group K1 (p = 0.0043). Diagnostic performance was assessed using the receiver operating characteristic (ROC) method. The threshold for differentiation between endometriosis patients and healthy non-operated controls was 42.3 ng/mL, with a sensitivity of 90% and specificity of 81%. For differentiation of patients and operated controls with benign gynaecological conditions, the threshold was 78.4 ng/mL, with a sensitivity of 61% and specificity of 95%. Conclusions: We, therefore, conclude that Arg-1 serum concentrations and arginase activity could be considered potential biomarkers for endometriosis but require further studies on larger cohorts of patients.