Outcomes after Laparoscopic Excision of Bladder Endometriosis Using a CO2 Laser: A Review of 207 Cases in a Single Center.

STUDY OBJECTIVE: Assess efficacy, safety, fertility outcomes and recurrence after laparoscopic resection of bladder endometriosis (BE) using a CO2 laser. DESIGN: Retrospective cohort study. SETTINGS: University gynecologic surgery unit, referral center for endometriosis. PATIENTS: A total of 207 women having undergone laparoscopic BE excision between January 1998 and January 2019. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Intra- and postoperative complication rates. Disease recurrence and fertility outcomes in patients with a minimum 1-year follow-up (n = 176) for "isolated" and "non-isolated" BE groups. RESULTS: Forty-three patients presented with isolated BE. Bladder "shaving" without mucosae opening was performed in 50.7% cases. No intraoperative complications were noted. One postoperative grade 3 complication was related to BE excision: a bladder breach requiring closure by repeat laparoscopy. Mean (± SD) follow-up was 7.05 (± 4.65) years. In patients wishing to conceive (n = 132), the total pregnancy rate (PR) was 75% (48.5% spontaneous), 76.19% in the isolated BE group (56.3% spontaneous). Among the 94 patients with previous infertility, 74.5% conceived, 50% spontaneously. No statistical difference was found in PR and need for in vitro fertilization between isolated and nonisolated BE groups. BE recurrence rate was 3.4%. No difference was observed between groups with full-thickness bladder resection (4/88) and shaving (2/88) (p = .406). Age at surgery (hazard ratio 0.91 [0.84-0.98], p = .016) and postoperative pregnancy (hazard ratio 0.07 [0.01-0.91], p = .042) showed influence on disease recurrence. CONCLUSIONS: The study demonstrates that laparoscopic BE removal is feasible with very low complications rates and was associated with high PR (both spontaneous and in vitro fertilization), even in patients with previous infertility. BE recurrence is lower than for other endometriosis locations. Bladder endometriosis; Laparoscopy; Deep infiltrating endometriosis; Fertility; Partial bladder resection.

Diet selection and trade-offs between condensed tannins and nutrients in parasitized sheep.

Foraging behavior by parasitized herbivores can be interpreted as a decision-making process where individuals are faced with trading-off the ingestion of nutrients with the ingestion of potentially medicinal -and toxic- plant secondary compounds. We determined how parasitized sheep prioritize selection of crude protein, energy and a medicinal plant secondary compound (quebracho tannins-QT). Foraging preferences were tested in 40 lambs before experiencing a parasitic infection (Phase 1), during an infection (Phase 2; 10,000 L3Haemonchus contortus per lamb) and after chemotherapy (Phase 3). Lambs were assigned to four groups (10 lambs/group) such that animals in Group 1 (Control) could choose between foods of high (HEP) or low (LEP) energy to protein ratios. The other groups received the same choice, but QT were added (4%) to HEP (Group 2), to LEP (Group 3) or to both foods (Group 4). All groups under a parasitic infection (Phase 2) increased their preference for HEP (from 0.44 to 0.66 ±â€¯0.042; P < 0.05) and intake of digestible energy (from 0.106 to 0.126 ±â€¯0.007 Mcal/kg BW; P < 0.05) relative to Phase 1, a pattern that remained during Phase 3. Only lambs receiving QT in HEP increased their intake of QT from Phase 1 to Phase 2 (P < 0.05). Fecal egg counts and blood parameters revealed a parasitic infection (P < 0.05) in Phase 2 that subsided in Phase 3, although no differences were detected among groups (P > 0.05). The importance of protein nutrition on parasitized animals has been highlighted before, but these results suggest that lambs prioritized the ingestion of energy-dense over protein-dense foods or medicinal condensed tannins when challenged by gastrointestinal parasitism. Consumption of medicinal tannins represented a side-effect of the preference manifested for energy-dense foods during testing.