Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.799
Filtrar
1.
Investig Clin Urol ; 64(1): 13-19, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36629061

RESUMO

PURPOSE: We investigated whether endoscopic interventions, including laser endoureterotomy and balloon dilatation following hormone therapy, are a good choice to treat ureteral obstruction due to ureteral endometriosis instead of laparoscopic or open surgery. MATERIALS AND METHODS: Patients with ureteral obstruction due to endometriosis who underwent endoscopic intervention between 2004 and 2021 were reviewed. Patients with other causes of ureteral obstruction or previous ureteral surgery were excluded from the study. The primary endpoint was the 3-month success rate of endoscopic intervention with or without hormone therapy. Secondary endpoints were the success rate of endoscopic intervention between the hormone-treated and hormone-untreated groups at 6 months and the success rate according to the hormone therapy response of endometriosis at 3 and 6 months. RESULTS: Eighteen patients with 19 ureter units were evaluated in this study, including 12 patients receiving hormone therapy and six patients not receiving hormone therapy. Among patients receiving hormone therapy, one patient had bilateral ureteral obstruction. The success rate of endoscopic intervention was higher in patients who received hormone therapy than in those who did not receive hormone therapy three months after endoscopic intervention (76.9% vs. 0.0%, p=0.003). The same result was also found 6 months after endoscopic intervention (75.0% vs. 0.0%, p=0.005). In addition, the success rates were higher in the hormone-responsive group than in the non-responsive group (100.0% vs. 57.1%), although the difference was not statistically significant (p=0.122). CONCLUSIONS: Ureteral obstruction caused by endometriosis can be effectively treated by endoscopic intervention with hormone therapy in select patients.


Assuntos
Endometriose , Ureter , Obstrução Ureteral , Feminino , Humanos , Obstrução Ureteral/cirurgia , Obstrução Ureteral/complicações , Ureteroscopia/efeitos adversos , Endometriose/complicações , Endometriose/cirurgia , Ureter/cirurgia , Hormônios
2.
BMC Womens Health ; 23(1): 37, 2023 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-36703173

RESUMO

BACKGROUND: Extrapelvic endometriosis occurring at skeletal muscle and joint sites is not rare and is prone to delayed diagnosis and inappropriate treatment. Herein, endometriosis of the skeletal muscular system (ESMS) is systematically reviewed to facilitate early diagnosis and treatment. METHODS: Literature on ESMS published before March 2022 was retrieved from the Ovid Medline and Web of Science databases, and the major clinical data were extracted for descriptive analysis. RESULTS: A total of 62 studies (78 ESMS cases) met these requirements. The ESMS included the abdominal muscles (50.7%), pelvic floor muscles (11.6%), lower limb muscles (11.6%), hip muscles (8.7%), lumbar muscles (7.2%), joints (5.8%), upper limb muscles (2.9%), and shoulder-neck muscles (1.4%). The age was 34.0 ± 7.2 years (range 17-49 years). Approximately 63.8% of patients had at least one previous pelvic surgery, and 76.8% of local symptoms were related to the menstrual cycle. The course of disease was 29.6 ± 25.4 months (range 0.5-96 months). Only 30.3% of the patients sought initial medical advice from gynecologists, while 69.7% sought initial medical advice from a nongynecological physician. Twenty-seven patients underwent fine-needle aspiration (FNA) under ultrasound or CT monitoring, and only 44.4% (12/27) were confirmed to have endometriosis by FNA tissue pathology. Approximately 47.4% (37/78) of the patients had a normal pelvic cavity appearance. Surgical resection was performed in 92.3% (72/78) of the patients, of whom 88.9% (64/72) underwent complete resection of the lesion (negative surgical margin) and 20.8% (15/72) received postoperative hormone therapy. At 16.7 months of follow-up, 83.3%, 13.8%, 2.9%, and four patients had complete response, partial response, recurrence, and permanent function impairment, respectively. CONCLUSION: Endometriosis can occur at almost any site in the musculoskeletal system. For women of reproductive age with catamenial pain or a mass in the musculoskeletal system, endometriosis should be suspected. Fine-needle aspiration can easily lead to missed diagnoses. Surgical resection for negative margins is the main treatment, and permanent impairment of function may occur in a few patients due to delayed diagnosis. Vascular lymphatic metastasis is the most likely mechanism of pathogenesis.


Assuntos
Endometriose , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Endometriose/diagnóstico , Endometriose/cirurgia , Endometriose/patologia , Dismenorreia , Ciclo Menstrual , Músculo Esquelético , Ultrassonografia
3.
In Vivo ; 37(1): 357-365, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593051

RESUMO

BACKGROUND/AIM: Endometriosis is a benign condition affecting 10-20% of women at reproductive age. The urinary tract is affected in 0.3-12.0% of women with endometriosis and in 19.0-53.0% of women with deep infiltrating endometriosis. The bladder is the most commonly affected organ in the urinary tract with a prevalence of up to 80%. Bladder endometriosis is defined as the occurrence of endometrial glands and stroma in the detrusor muscle. The aim of the study was to present the detailed technique and intraoperative and postoperative outcomes of laparoscopic resection of bladder endometriosis. PATIENTS AND METHODS: This was a retrospective study analyzing all surgical procedures, carried out at the Academic Hospital Cologne Weyertal between January 2014 and December 2022. In total 23,862 surgical reports were analyzed, and only patients (n=33 patients) with bladder endometriosis were included in the study. RESULTS: Follow-up was performed in 25 patients by phone contact. Twenty-three patients (92%) reported an improvement of symptoms, especially of dysuria, and an increase of quality of life. Only two patients (8%) reported no change in symptoms (dysmenorrhea and dyspareunia). Two patients (8%) reported bladder dysfunction. Mild postoperative pollakiuria was reported by two patients (8%). Four patients (with mild bladder dysfunction and pollakiuria) were satisfied with postoperative results owing significant improvement of symptoms and increasing the quality of life. CONCLUSION: Surgical treatment of bladder endometriosis can be performed by a gynecologist. In cases where a ureteroneocystostomy is required or the localization of endometriosis nodule is unfavorable, an intervention by a multidisciplinary team is recommended. Laparoscopic partial cystectomy and shaving seem to be an appropriate method for improving urinary symptoms. This surgical approach requires excellent laparoscopic skills.


Assuntos
Endometriose , Laparoscopia , Doenças da Bexiga Urinária , Humanos , Feminino , Bexiga Urinária/cirurgia , Endometriose/cirurgia , Estudos Retrospectivos , Qualidade de Vida , Doenças da Bexiga Urinária/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Resultado do Tratamento
4.
Obstet Gynecol ; 141(2): 371-374, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649332

RESUMO

We used a claims database to identify patients with uterine leiomyomas who underwent hysterectomy between 2011 and 2019. Use of conservative medical and surgical interventions in the 24-month period before hysterectomy was explored. Overall, 59.7% of patients did not receive any conservative intervention before hysterectomy. Individuals who underwent hysterectomy in more recent years and those with endometriosis, abnormal bleeding, greater comorbidity, or prior venous thromboembolism were more likely to receive conservative interventions.


Assuntos
Endometriose , Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Neoplasias Uterinas/cirurgia , Tratamento Conservador , Leiomioma/cirurgia , Histerectomia , Endometriose/cirurgia
5.
Taiwan J Obstet Gynecol ; 62(1): 155-157, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36720530

RESUMO

OBJECTIVE: We present a case of spontaneous abdominal wall endometriosis presenting as a painless nodular mass in a woman with no prior history of abdominal surgery. CASE REPORT: Abdominal wall endometriosis (AWE) is an uncommon form of endometriosis, usually arising due to a past history of cesarean section or abdominal hysterectomy. However, in rare cases, abdominal wall endometriosis can arise in women with no prior history of abdominal surgery. A 48-year-old woman presented to our obstetrics and gynecology clinic with a painless nodular mass in the right lower quadrant of the abdomen. Abdominal wall ultrasound showed a hypoechoic heterogenous mass under the skin. Wide surgical resection of the mass was conducted and post-operative histopathological report revealed abdominal wall endometriosis. CONCLUSION: Spontaneous abdominal wall endometriosis is an uncommon pathologic condition in which accurate diagnosis is difficult. As an increasing number of obstetrical and gynecological procedures are conducted worldwide, surgeons should keep this clinical entity in the differential diagnosis of any abdominal mass in reproductive-aged females regardless of their past surgical history.


Assuntos
Parede Abdominal , Endometriose , Feminino , Gravidez , Humanos , Adulto , Pessoa de Meia-Idade , Endometriose/diagnóstico , Endometriose/cirurgia , Endometriose/patologia , Parede Abdominal/cirurgia , Cesárea/efeitos adversos , Histerectomia/efeitos adversos , Pele/patologia , Cicatriz/complicações
6.
BMJ Open ; 13(1): e067497, 2023 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-36599637

RESUMO

INTRODUCTION: Overall, 20%-30% of women with endometriosis report endometriosis-related disability after successful laparoscopy. This indicates a potential impact of psychological factors, such as expectations, on treatment outcomes. It is already known that expectations determine treatment outcomes in various health conditions, such as cardiologic or gynaecology. Therefore, we investigate the impact of expectations and other psychological factors on patients' course of treatment outcomes after laparoscopy. METHODS AND ANALYSIS: A longitudinal mixed-methods study with N=300 women treated at a specialised centre of surgical endoscopy and endometriosis will be conducted with one preoperative and eight postoperative assessments of endometriosis-related disability and a priori specified predictors such as expectations.Additionally, two subsamples (each ~n=30) will be either interviewed about their endometriosis-related disability, expectations, and experiences of laparoscopy before and after surgery or asked once per day for 30 consecutive days using ambulatory assessments. Quantitative data will be analysed using multilevel modelling for longitudinal data. Structural content analysis will be used for qualitative data. DISCUSSION: To optimise treatment for women with endometriosis, it is essential to understand how treatment expectations and other psychological and medical factors influence treatment outcomes after laparoscopy. ETHICS AND DISSEMINATION: The Ethics Committee of the Psychotherapeutenkammer Hamburg, Germany, gave ethical approval (ROXWELL-2021-HH, 25 June 2021). TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT05019612).


Assuntos
Endometriose , Laparoscopia , Humanos , Feminino , Endometriose/cirurgia , Motivação , Estudos de Coortes , Laparoscopia/métodos , Resultado do Tratamento , Estudos Observacionais como Assunto
7.
J Minim Invasive Gynecol ; 30(1): 61-72, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36591808

RESUMO

STUDY OBJECTIVE: To evaluate ultrasonographic findings as a first-line imaging tool to indirectly predict the presence of parametrial endometriosis (PE) in women with suspected deep endometriosis (DE) undergoing surgery. DESIGN: Retrospective analysis of a prospectively collected database (ULTRA-PARAMETRENDO I study; NCT05239871). SETTING: Referral center for DE. PATIENTS: Consecutive patients undergoing laparoscopic surgery for DE. INTERVENTIONS: Preoperative transvaginal ultrasonography was done according to the International Deep Endometriosis Analysis consensus statement. A stepwise forward regression analysis was performed considering the simultaneous presence of DE nodules and the following ultrasonographic indirect signs of DE: diffuse adenomyosis, endometriomas, ovary fixed to the lateral pelvic wall or the uterine wall, absence of anterior/posterior sliding sign, and hydronephrosis. The gold standard for the presence of PE was surgery with histologic confirmation. MEASUREMENTS AND MAIN RESULTS: Of 1079 patients, 212 had a surgical diagnosis of PE (left: 18.5%; right: 17.0%; bilateral: 15.9%). The obtained prediction model (χ2 = 222.530; p <.001) for PE included, as independent indirect DE signs presence of hydronephrosis (odds ratio [OR] = 14.5; p = .002), complete absence of posterior sliding sign (OR = 3.3; p <.001), presence of multiple endometriomas per ovary (OR = 3.0; p = .001), and ovary fixation to the uterine wall (OR = 2.4; p <.001); as independent concomitant DE nodules, presence of uterosacral nodules with the largest diameter >10 mm (OR = 3.2; p <.001), presence of rectal endometriosis with the largest diameter >25 mm (OR = 2.3; p = .004), and rectovaginal septum infiltration (OR = 2.3; p = .003). The optimal diagnostic balance was obtained considering at least 2 concomitant DE nodules and at least 1 indirect DE sign (area under the curve 0.75; 95% confidence interval, 0.72-0.79). CONCLUSION: Specific indirect ultrasonographic findings should raise suspicion of PE in women undergoing preoperative assessment for DE. The suspicion of parametrial invasion may be critical to address patients to expert leading centers, where proper diagnosis and surgical treatment for PE can be performed.


Assuntos
Endometriose , Laparoscopia , Neoplasias Peritoneais , Humanos , Feminino , Endometriose/complicações , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Sensibilidade e Especificidade , Estudos Retrospectivos , Reto/patologia , Vagina/diagnóstico por imagem , Vagina/cirurgia , Vagina/patologia , Laparoscopia/métodos , Neoplasias Peritoneais/cirurgia , Ultrassonografia/métodos
8.
Eur J Obstet Gynecol Reprod Biol ; 280: 174-178, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36508855

RESUMO

OBJECTIVE: The aim of the study was to investigate pregnancy and live birth rate after surgical resection of rectosigmoid deep infiltrating endometriosis (DIE), and study if complications affect these rates. STUDY DESIGN: Historical case series. 193 patients with rectosigmoid DIE and pregnancy intention undergoing a rectosigmoid resection for DIE from January 2009 to May 2019. All operations were performed at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark. Surgical and fertility outcome data were obtained through patient files. Anonymized data was analyzed statistically. Normally distributed continuous variables are stated as means, categorical data as percentages and time to pregnancy as Kaplan-Meier failure function. Live birth rates stratified on complications were tested with chi2 test. RESULTS: 117 patients became pregnant postoperatively with a pregnancy and live birth rate of 60.6% and 53.9%, respectively. 39 patients (20.2%) became pregnant spontaneously and 78 patients (40.4%) by intrauterine insemination or assisted reproductive technologies. Median time to pregnancy after surgery was 12.4 months (range: 0.4-58). Clavien-Dindo complication grade III (none grade IV) was registered among 16.6%. These patients had pregnancy and live birth rates of 50%, not statistically significantly different from those without complications. CONCLUSIONS: Postoperative pregnancy and live birth rates after resection of rectosigmoid endometriosis in this study are in line with conservative treatment, when comparing with the literature. Interestingly, complications (Clavien-Dindo grade III) did not affect live birth rate or time to pregnancy.


Assuntos
Endometriose , Infertilidade Feminina , Laparoscopia , Doenças Retais , Gravidez , Feminino , Humanos , Endometriose/complicações , Endometriose/cirurgia , Infertilidade Feminina/etiologia , Taxa de Gravidez , Fertilidade , Coeficiente de Natalidade , Resultado do Tratamento , Estudos Retrospectivos , Doenças Retais/cirurgia , Laparoscopia/efeitos adversos
9.
Eur J Obstet Gynecol Reprod Biol ; 280: 184-190, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36516605

RESUMO

OBJECTIVE: To compare first-line surgery with first-line assisted reproductive techniques (ART) in infertile women with deep infiltrating endometriosis (DIE) without colorectal involvement. STUDY DESIGN: A retrospective comparative cohort study with a propensity-score matching analysis, in four tertiary-care referral centers. The population was infertile women with DIE without colorectal involvement. The patients were managed either by first-line surgery followed by spontaneous conception attempts and/or ART, or by first-line ART. 284 patients were extracted from the databases. After matching, 92 patients were compared in each group. Clinical pregnancy rates (PR) and live-birth rates (LBR) were the primary outcomes, and cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) were the secondary outcomes. RESULTS: The mean number of IVF-ICSI cycles per patient was 1.4, with a significant difference between the groups: 1.6 in the first-line ART group and 1.2 in the first-line surgery group (p = 0.006). The PR was significantly higher in the first-line surgery group (72 % vs 35 %; p < 0.001). In the first-line surgery group, non-ART pregnancies occurred in 18 % (17/92) while no non-ART pregnancies was noted in the first-line ART group. The LBR was significantly higher in the first-line surgery group (61 % vs 24 %; p < 0.001). After ART, the CPR were 72 % (47/67) in the first-line surgery group, and 35 % (32/92) in the first-line ART group (p < 0.001). CONCLUSION: After matching, our results support that first-line surgery offer higher pregnancy and live-birth rates than first-line ART in patients with DIE without colorectal involvement.


Assuntos
Neoplasias Colorretais , Endometriose , Infertilidade Feminina , Gravidez , Humanos , Feminino , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Endometriose/complicações , Endometriose/cirurgia , Endometriose/epidemiologia , Estudos de Coortes , Estudos Retrospectivos , Técnicas de Reprodução Assistida , Coeficiente de Natalidade , Neoplasias Colorretais/complicações , Taxa de Gravidez , Fertilização In Vitro/métodos , Nascido Vivo
11.
BMC Womens Health ; 22(1): 538, 2022 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-36550530

RESUMO

BACKROUND: Endometriosis is one of the most common gynecological illnesses causing extensive psychological, physical and social impact on patient's life and exerts negative effects on health-related quality of Life (HRQoL). However, the effects of surgery on the postoperative HRQoL in the different endometriosis subgroups have not been fully evaluated. METHODS: We performed a comparative retrospective study between 2014 and 2018 at the Medical University of Vienna, including all patients with surgically confirmed endometriosis who had completed the standardized Endometriosis Health Profile-30 (EHP-30) questionnaire 1 day after surgery (the questions refer to the 4 weeks preoperatively) and 6-10 weeks postoperatively. RESULTS: Compared to preoperative values, we found significant benefits, regarding postoperative conditions, in our study group (n = 115) in all five categories, "pain" (HR 0.78, p < 0.001); "self-determination" (HR 0.92, p < 0.001); "emotional health" (HR 0.83, p < 0.001);" social environment" (HR 0.67, p < 0.001); and "self-image" (HR 0.47, p < 0.001). Patients with only peritoneal endometriosis had the lowest preoperative clinical symptoms and there were no significant changes in any of the categories. In the subgroups deep infiltrating endometriosis (DIE) and DIE + ovarian endometrioma, surgical intervention results in a significantly greater improvement in all categories of EHP 30 compared to ovarian endometrioma without DIE or peritoneal endometriosis. CONCLUSION: Our study shows, that especially women with DIE-with or without ovarian endometrioma-demonstrate a more pronounced benefit from surgical therapy compared to patients with peritoneal endometriosis or endometrioma without DIE.


Assuntos
Endometriose , Laparoscopia , Humanos , Feminino , Endometriose/cirurgia , Endometriose/complicações , Estudos Retrospectivos , Qualidade de Vida , Laparoscopia/efeitos adversos , Dor Pélvica/etiologia , Inquéritos e Questionários
12.
BMC Pregnancy Childbirth ; 22(1): 954, 2022 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-36544091

RESUMO

BACKGROUND: Cesarean scar defect (CSD) presents as a cystic defect that connects the uterine cavity at the site of the previous cesarean section (CS). Endometriosis refers to the discovery of endometrial glands and stroma outside the uterine cavity. Cases of endometriosis cysts at CSD have not been reported. CASE PRESENTATION: In this article, we will present a patient with an endometriosis cyst at CSD with symptoms of a prolonged menstrual cycle, periods without cyclic abdominal pain, and a history of cesarean delivery. The gynecologic ultrasound showed a CSD and a mixed mass in the right front of the uterus. After about 1 month, the tumor grew from a diameter of 4.75 cm to 8.06 × 6.23 × 3.66 cm. The patient eventually had an operation, which revealed a mass protruding from the incision in the anterior uterine wall, which was attached to the anterior uterine wall by a thin tip with a smooth surface. Intraoperative rapid cytopathology suggested that endometrial glands were seen within the smooth muscle tissue, similar to endometriosis. Subsequently, the patient underwent resection of the endometriotic cyst. Final paraffin pathology showed smooth muscle with visible endometrial glands and old hemorrhage, and a one-year follow-up showed no recurrence of endometriosis cysts at CSD. CONCLUSIONS: Endometriosis cysts at CSD are very rare. The clinical symptoms may be less obvious, and the diagnosis relies mainly on the patient's previous surgical history and imaging. A finding of a pelvic mass in the location of the CSD, with or without symptoms of menstrual changes and intermittent abdominal pain, should be considered an endometriotic cyst at CSD. Surgical treatment is a good choice for this disease. Further studies are needed regarding the etiological mechanism of this case and why the mass enlarged rapidly in one mouth.


Assuntos
Cistos , Endometriose , Feminino , Gravidez , Humanos , Endometriose/complicações , Endometriose/cirurgia , Endometriose/diagnóstico , Cicatriz/complicações , Cicatriz/diagnóstico por imagem , Cesárea/efeitos adversos , Dor Abdominal , Cistos/diagnóstico por imagem , Cistos/etiologia , Cistos/cirurgia
13.
Med Sci Monit ; 28: e938637, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36518029

RESUMO

BACKGROUND Endometriosis is a progressive disease, and early detection and early treatment are particularly important. The purpose of this study was to investigate the effect of the timing of laparoscopy on the spontaneous pregnancy rate of primary infertile patients complicated with pelvic effusion within 6 months after surgery. MATERIAL AND METHODS We enrolled 330 primary infertile patients with pelvic effusion and bilateral patent fallopian tubes. They were divided into 3 groups based on retrospective analysis of clinical data. Study Group 1 underwent laparoscopy 1 month after hysterosalpingography (HSG), Study Group 2 received laparoscopy after trying to conceive for 3 months, and the Control Group did not undergo laparoscopy. According to the specific conditions during laparoscopy, repair and plastic surgery of fallopian tube, electrocautery of endometriosis and uterine suspension were performed. The main observation indicators were proportions of retrograde menstruation, peritoneal endometriosis, and tubal adhesions in laparoscopy groups, and spontaneous pregnancy rates within 6 months. RESULTS The proportions of retrograde menstruation were 92.2% and 93.1% in Study Group 1 and Study Group 2, respectively, with no statistical significance. The proportions of peritoneal endometriosis were 51.0% and 64.7%, with a statistically significant difference. The proportions of tubal adhesions were 31.4% and 36.2%, with no statistical significance. The pregnancy rates within 6 months were 73.9%, 52.6%, and 13.1%, with a statistically significant difference for pairwise comparisons. CONCLUSIONS The pregnancy rate of primary infertile patients with patent fallopian tubes complicated with pelvic effusion can be significantly improved through early laparoscopic surgery (exploration and treatment).


Assuntos
Endometriose , Doenças das Tubas Uterinas , Infertilidade Feminina , Laparoscopia , Gravidez , Feminino , Humanos , Tubas Uterinas/cirurgia , Tubas Uterinas/patologia , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/cirurgia , Doenças das Tubas Uterinas/diagnóstico , Endometriose/complicações , Endometriose/cirurgia , Endometriose/patologia , Estudos Retrospectivos , Infertilidade Feminina/cirurgia , Laparoscopia/efeitos adversos , Aderências Teciduais/patologia , Distúrbios Menstruais/complicações , Distúrbios Menstruais/patologia , Distúrbios Menstruais/cirurgia
14.
Khirurgiia (Mosk) ; (12. Vyp. 2): 54-58, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36562673

RESUMO

OBJECTIVE: To study the early postoperative outcomes of segmental bowel resections in patients with colorectal endometriosis. MATERIAL AND METHODS: A retrospective study included 60 patients diagnosed with deep infiltrative endometriosis who underwent surgical treatment with segmental bowel resection between 2016 and 2022. RESULTS: All surgeries performed by two teams (gynecologic & colorectal). 59 operations were performed by laparoscopic access and one open. The average operation time was 263.5±86.0 min, estimated blood loss 126.1 ml (10-400 ml). There were no intraoperative complications. There were no conversions during laparoscopic surgery. A protective stoma was not required in any patient. The median postoperative hospital stay was 7.5±4.2 days. Bowel function was restored by an average of 4.3±3.1 days. Postoperative complications were in 7 cases (11.6%). Anastomotic leakage occurred in one patient (1.6%). The incidence of urine retention requiring repeated bladder catheterization was 2 (3.3%). CONCLUSION: The use of a minimally invasive multidisciplinary approach makes it possible to perform the required volume of surgery with excision of all tissues affected by endometriosis with a low level of complications and the absence of conversions.


Assuntos
Neoplasias Colorretais , Procedimentos Cirúrgicos do Sistema Digestório , Endometriose , Laparoscopia , Doenças Retais , Humanos , Feminino , Doenças Retais/diagnóstico , Doenças Retais/cirurgia , Doenças Retais/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Colorretais/cirurgia , Resultado do Tratamento
15.
BMC Womens Health ; 22(1): 553, 2022 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-36577953

RESUMO

OBJECTIVE: This study aimed to determine the quality of life (QOL), in patients with endometriosis ± infertility (B and C groups) and compare those to healthy women, and also infertile groups without endometriosis as a control groups (A and D), considering the fact that endometriosis and infertility reduces the quality of life in patients. METHODS: The present prospective comparative study was carried out between January 2018 and September 2020. A total of 400 women were included (100 women in each group). The participants filled in a validated questionnaire of quality of life, Endometriosis Health Profile-30 (EHP-30), and a visual analog scale of pain used, at the first visit, and 3 months after the medical or surgical treatment in the endometriosis group without infertility, additionally. RESULTS: The majority of the patients were married, categorized in the middle-class of socio-economic state and housewives. They were of Persian descent. BMI was high in the infertile groups; however, the time of infertility was not different between the two groups of B and C (P = 0.054). The mean score of QOL was significantly lower in B, C, and D groups in comparison to the healthy women as the control group (A) (P < 0.001). Moreover, the infertile group (B), in comparison to endometriosis ± infertility groups (C and D), had the lowest mean score of QOL (P < 0.001). In each group, those who were older and had better educational level reported a better quality of life than other participants in that group. Social support plays a very important role in reducing the endometriosis related pain symptoms both before and after treatment. Three months after the treatment of endometriosis (D), a significant improvement was observed in all the aspects of QOL-related endometriosis. Nonetheless, the improvement of the quality of life in the surgical group was significantly higher than that in the medical treatment. The mean visual analog score of pain decreased from 62.22 ± 22.78, to 5.15 ± 2.73 following the surgical treatment (P < 0.001). CONCLUSION: The lowest quality of life belonged to the infertile group, followed by the endometriosis group. The quality of life of the endometriosis group improved after the treatment. Thus, endometriotic patients' treatment in terms of improvement of quality of life should be considered by all professional health care teams.


Assuntos
Endometriose , Infertilidade Feminina , Humanos , Feminino , Endometriose/complicações , Endometriose/cirurgia , Endometriose/diagnóstico , Qualidade de Vida , Estudos Prospectivos , Dor Pélvica , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Inquéritos e Questionários
16.
Artigo em Inglês | MEDLINE | ID: mdl-36554635

RESUMO

INTRODUCTION: Umbilical endometriosis (UE) is defined as the presence of endometrial-like tissue within the umbilicus and represents around 0.5-1% of all cases of endometriosis. UE is classified into primary or secondary UE. In this retrospective study, we aimed to assess symptoms, signs, recurrence rate of treated lesions, psychological wellbeing and health-related quality of life in women with UE. MATERIAL AND METHODS: We retrospectively reviewed all cases of women diagnosed with UE in the period 1990-2021 in our center. Post-operative recurrence of UE was considered as the reappearance of the umbilical endometriotic lesion, or as the recurrence of local symptoms in the absence of a well-defined anatomical recurrence of the umbilical lesion. Moreover, participants were invited to fill in standardized questionnaires on their health conditions. RESULTS: A total of 55 women with histologically proven UE were assessed in our center during the study period. At time of diagnosis, local catamenial pain and swelling were reported by 51% and 53.2% of women, respectively. A total of 46.8% of women reported catamenial umbilical bleeding. Concomitant non-umbilical endometriosis was identified in 66% of cases. As regards the treatment of UE, 83.6% of women underwent an en-bloc excision with histological confirmation of UE. During the follow-up period, 37 women (67.3%) agreed to undergo a re-evaluation. Recurrence of either umbilical symptoms, or umbilical nodule, was observed in 27% of patients, 11% of which did not receive post-operative hormonal therapy. Specifically, a recurrence of the umbilical endometriotic lesion was observed only in two women. Among the 37 women which we were able to contact for follow-up, 83.8% were satisfied with the treatment they had received. CONCLUSIONS: The high rate of patient satisfaction confirmed that surgical excision should be considered the gold standard treatment for umbilical endometriosis. Future studies should investigate the role of post-operative hormonal therapy, particularly in reducing the risk of symptom recurrence.


Assuntos
Endometriose , Humanos , Feminino , Endometriose/cirurgia , Umbigo/cirurgia , Umbigo/patologia , Estudos Retrospectivos , Qualidade de Vida , Menstruação
18.
JBRA Assist Reprod ; 26(4): 620-626, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36350241

RESUMO

OBJECTIVE: To investigate the effect of endometriosis and its different stages over Intracytoplasmic Sperm Injection (ICSI) outcomes among infertile women without previous history of ovarian surgery. METHODS: A total of 440 women enrolled in ICSI cycles were recruited and divided into two groups: endometriosis (n=220) and control group (n=220). Endometriosis patients without previous surgical treatment and with diagnostic laparoscopy were further stratified based on disease stage. Clinical and laboratory parameters, ovarian reserve markers, the number and quality of oocytes and embryos and fertilization rate were analyzed and compared among the various severity grades of endometriosis and the control group. RESULTS: Patients with advanced endometriosis had significantly fewer retrieved oocytes with small effect size (p<0.001, η2=0.04), lower metaphase II oocytes (p<0.001, η2=0.09) and fewer total numbers of embryos (p<0.001, η2=0.11) compared with less severe disease or women with tubal factor infertility. The fertilization rate in women with severe endometriosis was similar to that of the control group and in those with minimal/mild endometriosis (p=0.187). CONCLUSIONS: Severe endometriosis negatively affects ovarian response, oocyte quality and embryos. However, fertilization rate is not different among the various stages of endometriosis.


Assuntos
Endometriose , Infertilidade Feminina , Masculino , Gravidez , Humanos , Feminino , Endometriose/complicações , Endometriose/cirurgia , Indução da Ovulação , Taxa de Gravidez , Fertilização In Vitro , Estudos Retrospectivos , Sêmen , Oócitos , Desenvolvimento Embrionário , Fertilização
19.
BMC Womens Health ; 22(1): 476, 2022 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-36435830

RESUMO

BACKGROUND: This retrospective study evaluated the clinical features of perineal endometriosis (PEM) and established a prognostic nomogram for recurrence probability in patients treated with surgical resection. METHODS: This study enrolled 130 PEM patients who had received surgical treatment in Peking Union Medical College Hospital (PUMCH) between January 1992 and September 2020. We collected their clinical features and conducted outpatient or telephone follow-up. The predictive nomogram was constructed based on 104 patients who had completed follow-up by July 2021. The Cox proportional hazards regression model was used to evaluate the prognostic effects of multiple clinical parameters on recurrence. The Index of concordance (C-index) and calibration curves were used to access the discrimination ability and predictive accuracy of the nomogram respectively, and the results were further validated via bootstrap resampling. Calculating the area under the curve (AUC) via risk scores of patients aimed to further access the predictive power of the model. In addition, the survival curve was depicted using Kaplan-Meier plot and compared by log-rank method. RESULTS: Most PEM patients had been symptomatic for 24-48 months before the lesion resection. With a median 99.00 (interquartile range: 47.25-137.50) months of postoperative observation, there were 16 (15.1%) out of 104 cases who finished follow-up reported symptomatic recurrence. On multivariate analysis of derivation cohort, multiple lesions, microscopically positive margin (mPM) and anal sphincter involvement (ASI) were selected into the nomogram. The C-index of the nomogram for predicting recurrence was 0.84 (95% CI 0.77-0.91). The calibration curve for probability of recurrence for 36, 60 and 120 months showed great agreement between prediction by nomogram and actual observation. Furthermore, the AUCs of risk score for 36, 60 and 120 months were 0.89, 0.87 and 0.82 respectively. CONCLUSIONS: PEM is a rare kind of endometriosis and surgery is the primary treatment. Multiple lesions and ASI are independent risk factors for postoperative recurrence, and wide resection with more peripheral tissue could be preferred. The proposed nomogram resulted in effective prognostic prediction for PEM patients receiving surgical excision. In addition, this predictive nomogram needs external data sets to further validate its prognostic accuracy in the future.


Assuntos
Endometriose , Nomogramas , Feminino , Humanos , Prognóstico , Estudos Retrospectivos , Endometriose/diagnóstico , Endometriose/cirurgia , Estudos de Coortes
20.
Medicine (Baltimore) ; 101(42): e31157, 2022 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-36281126

RESUMO

To evaluate the association between red blood cell (RBC) indices (mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], MCH concentration [MCHC], red cell distribution width [RDW], hemoglobin [Hb], hematocrit [Hct], and neutrophil-to-lymphocyte ratio [NLR]) and the severity of endometriosis. Data were obtained from the medical records of 200 patients with endometriosis (stage I/II and stage III/IV groups), and 100 patients with benign ovarian tumors (control group), treated between September 2011 and April 2021. The mean Hb and Hct were significantly lower in the stage III/IV group compared to those in the control and stage I/II group (P = .015 and P = .004, respectively). The mean MCV, MCH, and Hb at postoperative day (POD)#1 were significantly lower in the stage III/IV group compared to those in the control and stage I/II group (P = .007, P = .032, and P < .0001, respectively). In addition, NLR at POD#1 was significantly higher in stage III/IV group compared to that in the control and stage I/II group. Multivariate analysis revealed that younger age (≤38 years old), lower preoperative MCV (≤88.5 fL), lower POD#1 Hb (<11.6g/dL), and higher POD#1 NLR (>2.5) were independent risk factors of stage III/IV endometriosis. Lower levels of RBC indices, including preoperative MCV and postoperative Hb, and higher postoperative NLR were significantly associated with the severity of endometriosis, which is potentially derived from a dysregulation in iron metabolism and inflammation.


Assuntos
Endometriose , Índices de Eritrócitos , Feminino , Humanos , Adulto , Endometriose/cirurgia , Hemoglobinas , Biomarcadores , Eritrócitos , Ferro
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...