Danazol in the management of ureteral obstruction secondary to endometriosis

Rivlin, Michel E.; Krueger, Ronald P.; Wiser, Winfred L.

doi:10.1016/s0015-0282(16)48751-0

Cited by 38 publications

(14 citation statements)

References 5 publications

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“…33 In other words, older cysts, which have elevated iron, ferritin, and total bilirubin concentration in the cyst fluid concordant with higher density and viscosity, may be resistant to hormonal treatment simply because fibrotic tissues in general do not respond well to hormonal drugs. 34 Of course, other explanations, yet to be elaborated, may also be possible.…”

Section: Discussionmentioning

confidence: 99%

Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications

et al. 2015

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This study was undertaken to test the hypotheses that, due to gradual accumulation of dead erythrocytes and their ingested products resulting from repeated hemorrhage, older endometriomas (whitish in color) contain chocolate fluid with higher iron content than younger (brownish/blackish in color) ones with concomitant higher collagen content and more adhesions. We recruited 30 premenopausal women with histologically confirmed ovarian endometriomas and collected samples of their endometriotic lesions and chocolate fluid and measured the viscosity, density, and the concentration of total bilirubin, ferritin, and free iron of the chocolate fluid. We also evaluated the lesion color and adhesion scores. In addition, we performed Masson trichrome and Picro-Sirius red staining on all endometriotic cysts and evaluated the extent of fibrosis in the lesions. We found that fluids taken from white-colored endometriomas had significantly higher concentration of total bilirubin, ferritin, and free iron, respectively, than black/brown-colored ones. In addition, older cysts had fluids that had significantly higher density and viscosity. Fluid density correlated positively with the concentrations of total bilirubin, ferritin, and free iron. Older lesions had significantly more collagen content and higher adhesion scores. Taken together, these data supports the notion that older cysts, having experienced more bleeding episodes, contain chocolate fluid that is higher in viscosity, density, and iron content and higher fibrotic content than younger ones. This provides another piece of evidence that endometriotic lesions are wounds that undergo repeated injury and repair, resulting ultimately fibrotic lesions that are resistant to hormonal treatment.

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Section: Discussionmentioning

confidence: 99%

Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications

et al. 2015

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“…Treatment should be individualized according to age, reproductive desire, symptom severity, extent of lesions, and the involvement of other organs. If renal function is normal and there is minimal to mild hydronephrosis with no functional obstruction, hormone therapy should be prescribed [5][6][7]. Hormonal therapy has a poor response in patients with intrinsic ureteral disease or extensive endometriosis [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Lesions involving the urinary tract result in bloody urine in the perimenstrual periods with obstructive symptoms [5,6]. Medical treatment should be the initial treatment, but if it fails, and complications develop, surgical intervention is required [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Ureteric Endometriosis with Adenomyosis: A Rare Association Leading to the Death of a Kidney

Gupta¹,

Singh²,

Sinha³

et al. 2012

UIJ

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A 34-year-old female presented with recurrent right flank pain with severe dysmenorrhoea. She was diagnosed with a right parametrial mass encasing the right ureter, leading to severe hydroureteronephrosis and non-functioning kidney. Initially she was managed with danazol and showed a positive response but there was a relapse following cessation of danazol. Finally, we performed a right nephroureterectomy with total abdominal hysterectomy and a bilateral salpingo-oophorectomy. The histopathological examination showed right ureteric wall involvement of endometrial tissue, adenomyosis, and chocolate ovarian cysts. The patient is doing well in the last 12 months of follow-up. CONCluSIONUrinary tract imaging is recommended for every woman presenting with pelvic endometriosis. Judicious and timely intervention may prevent renal loss.

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“…Two progestins, norethindrone acetate and Depot Provera (104 mg SC; Pfizer, New York, NY), are approved by the U.S. Food and Drug Administration for treatment of endometriosis, but megestrol acetate is not approved for this indication. Cases of successful treatment of ureteral endometriosis with danazol and leuprolide acetate have been reported in the literature (14)(15)(16). However, the role of medical management in the treatment of ureteral endometriosis is not well established, and two cases of failed treatment with danazol have been reported (17).…”

Section: Discussionmentioning

confidence: 99%

Persistent bilateral ureteral obstruction secondary to endometriosis despite treatment with an aromatase inhibitor

Bohrer

Chen

Falcone

2008

Fertility and Sterility

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Danazol in the management of ureteral obstruction secondary to endometriosis

Cited by 38 publications

References 5 publications

Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications

Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications

Ureteric Endometriosis with Adenomyosis: A Rare Association Leading to the Death of a Kidney

Persistent bilateral ureteral obstruction secondary to endometriosis despite treatment with an aromatase inhibitor

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