Operative management of deep endometriosis infiltrating the uterosacral ligaments

Chapron, Charles; Dubuisson, Jean‐Bernard; Fritel, Xavier; Fernández, Bernal Herrera; Poncelet, C.; Béguin, Sandrine; Pinelli, Laurent

doi:10.1016/s1074-3804(99)80037-1

Cited by 85 publications

(54 citation statements)

References 20 publications

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“…The T1 hyperintense content of both cysts persists after fat suppression while the irregular wall of the cyst does not demonstrate enhancement after intravenous contrast injection (arrow). Pathology confirmed the diagnosis of bilateral endometriomas [31]. Clinical examination has been described as normal in 67% of patients with endometriosis of the uterosacral ligaments [32], making further imaging studies necessary for diagnosis and treatment.…”

Section: Endometriosis Of Uterosacral Ligaments and Torus Uterinusmentioning

confidence: 72%

Diagnosis of endometriosis with imaging: a review

et al. 2005

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Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed.

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Section: Endometriosis Of Uterosacral Ligaments and Torus Uterinusmentioning

confidence: 72%

Diagnosis of endometriosis with imaging: a review

et al. 2005

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“…Research has shown that surgical treatment of DIE is recommended for symptomatic disease resulting in compromised quality of life. Complete excision of the affected area seems to provide long-term pain relief and improved quality of life with a low recurrence rate in most patients with DIE (24)(25)(26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative ureteral endometriosis

Azioni

Bracale²,

Scala

et al. 2010

Minimally Invasive Therapy & Allied Technologies

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The aim of the study was to assess the safety and efficacy of laparoscopic treatment of distal infiltrative ureteral endometriosis with segmental ureteral resection, ureteroneocystostomy, and vesicopsoas hitch. We performed a retrospective analysis of perioperative data and looked at follow-up outcomes of patients with deep endometriosis with ureteral involvement treated by laparoscopic vesicopsoas hitch. Six patients were treated for left ureteral endometriosis in the study period. Four of those were diagnosed during previous laparoscopies. A ureteroneocystostomy (Lich-Gregoir reimplantation procedure) with vesicopsoas hitch was fashioned laparoscopically in all cases, and a double-J stent was applied intraoperatively. There were no intraoperative or postoperative complications and no cases of extravasation of contrast at cystogram one week after surgery. The median follow-up time was 38 months (range 12-56). All patients had normal renal ultrasound or intravenous pyelogram results at one year follow-up. This study confirmed that laparoscopic ureteroneocystostomy and vesicopsoas hitch is a safe and effective option in the management of distal ureteral endometriosis. In view of the small size of this series, multicenter studies are needed to confirm these conclusions.

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“…Gyakoriságát a reproduktív korú női populációban 6-10% közé teszik [1][2][3]. Külön entitásként elkülönítik az összes eset körülbe-lül 20%-át kitevő [4,5] mélyen infiltráló endometriosist (deep infiltrating endometriosis -DIE), amely esetén az elváltozás a peritoneum szintjétől 5 mm-nél mélyebbre terjed [6,7].…”

Section: Eredeti Közleményunclassified

Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban

et al. 2017

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Bevezetés és célkitűzés:A colorectalis rendszert érintő endometriosis ellátása multidiszciplináris laparoszkópos teammel javasolt. A bélinfiltráció preoperatív felismerése ehhez elengedhetetlen. Betegek és módszer: 2009-2015 között prospektíven 383, endometriosissal diagnosztizált betegnél történt sigmoideoscopia. Intraluminalis endometriosis, fali infiltrációra jellemző másodlagos jelek (falmerevség, benyomat, megtöretés, vizsgálat alatti fájdalom, suffusio) kerül-tek feldolgozásra. Műtéti indikáció esetén a pozitív esetek multidiszciplináris, a negatív esetek nőgyógyász által vég-zett műtéten estek át. Eredmények: 224 (58,49%) pozitívnak talált beteg közül 108-nál multidiszciplináris műtét történt, a negatívnak bizonyult esetek közül 135 ginekológiai műtéten esett át. 108-ból 103 betegnél a műtét során is igazolódott a bél érintettsége, míg a negatív esetek közül nyolc esetben volt jelentős bélinfiltráció. Teljes sigmoideoscopiás vizsgálat 43,4%-ban volt kivitelezhető. Intraluminalis endometriosis 4,91%-ban, fali merevség 38,39%-ban, benyomat 45,54%-ban, megtöretés 57,14%-ban, fájdalom (narkózis nélkül végzett vizsgálatoknál) 26,06%-ban, suffusio 3,82%-ban fordult elő. A sigmoideoscopia szenzitivitása: 92,8%, specificitása: 96,2% volt. Következtetés: A sigmoideoscopia -tapasztalt endoszkópos esetében -kiemelkedő szenzitivitású eszköz a belet infiltráló endometriosis igazolásában. Orv. Hetil., 2017, 158(7), 264-269.Kulcsszavak: sigmoideoscopia, mélyen infiltráló endometriosis, bélinfiltráció, sebészet Prospective study to determine the diagnostic sensitivity of sigmoidoscopy in bowel endometriosis Introduction and aim: In the treatment of colorectal endometriosis a multidisciplinary laparoscopic resection is suggested, for this reason the correct selection of bowel infiltration is essential before surgery. Patients and method: Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. In endoscopically confirmed cases multidisciplinary surgery was performed, the remaining patients were operated by a gynecologic team only. Results: Endometriosis was endoscopically confirmed in 224 patients (58.49%), 108 of them underwent multidisciplinary operation, the negative 135 cases received gynaecological surgery. Bowel endometriosis was confirmed in 103 out of 108 cases intraoperatively, while in 8 cases of the sigmoidoscopically negative patients bowel infiltration was diagnosed intraoperatively by the gynaecological team. Complete sigmoidoscopy was performed in 43.47% of the cases. Intraluminal endometriosis was found in 4.91%, secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis) in 26.06% and suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. Conclusion: Sig...

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Operative management of deep endometriosis infiltrating the uterosacral ligaments

Cited by 85 publications

References 20 publications

Diagnosis of endometriosis with imaging: a review

Diagnosis of endometriosis with imaging: a review

Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative ureteral endometriosis

Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban

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