To Excise or Ablate Endometriosis? A Prospective Randomized Double-Blinded Trial After 5-Year Follow-Up

Healey, Martin; Cheng, Claudia; Kaur, Harvinder

doi:10.1016/j.jmig.2014.04.002

Cited by 52 publications

(49 citation statements)

References 9 publications

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“…However this study had a larger number of patients with DIE in the excision group rather than ablation group, limiting the generalizability of the observations. A follow up to this study also showed better relief of dyspareunia with excision 12 . Excision of an endometrioma cyst wall has been shown to have superior outcomes than ablation in terms of pain, recurrence, need for surgery and fertility 13 .…”

Section: Introductionsupporting

confidence: 66%

Retroperitoneal Anatomy during Excision of Pelvic Side Wall Endometriosis

Gingold

Falcone

2016

Journal of Endometriosis and Pelvic Pain Disorders

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Surgical management of endometriosis has been shown to improve dysmenorrhea at all disease stages and is recommended in severe disease for treatment of infertility. Deeply infiltrating endometriosis (DIE) produces thick inflammatory tissue that precludes visualization of anatomical landmarks and distorts normal anatomy. Excision of DIE poses several technical and surgical challenges that mandate a clear understanding of the anatomy of the pelvic sidewall. This review details relevant surgical anatomy and addresses the principles of safe retroperitoneal entry, ureterolysis and excision of endometriotic lesions. Proper use of these techniques should facilitate safe and successful surgery for management of DIE.

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Section: Introductionsupporting

confidence: 66%

Retroperitoneal Anatomy during Excision of Pelvic Side Wall Endometriosis

Gingold

Falcone

2016

Journal of Endometriosis and Pelvic Pain Disorders

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“…In fact, long-term results of a randomized controlled trial showed that excision was superior to ablation specifically for the outcome of dyspareunia. 30 In addition, local neurogenesis may provide another therapeutic target for endometriosis. 31 For future research, we are investigating the factors that mediate the increase in nerve bundles in some women with endometriosis (eg, nerve growth factor and its receptors).…”

Section: Discussionmentioning

confidence: 99%

Nerve Bundles and Deep Dyspareunia in Endometriosis

et al. 2016

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The etiology of deep dyspareunia in endometriosis is unclear. Our objective was to determine whether nerve bundle density in the cul-de-sac/uterosacrals (zone II) is associated with deep dyspareunia in women with endometriosis. We conducted a blinded retrospective immunohistochemistry study (n = 58) at a tertiary referral center (2011-2013). Patients were stringently phenotyped into a study group and 2 control groups. The study group (tender endometriosis, n = 29) consisted of patients with deep dyspareunia, a tender zone II on examination, and an endometriosis lesion in zone II excised at surgery. Control group 1 (nontender endometriosis, n = 17) consisted of patients without deep dyspareunia, a nontender zone II on examination, and an endometriosis lesion in zone II excised at surgery. Control group 2 (tender nonendometriosis, n = 12) consisted of patients with deep dyspareunia, a tender zone II on examination, and a nonendometriosis lesion (eg, normal histology) in zone II excised at surgery. Protein gene product 9.5 (PGP9.5) immunohistochemistry was performed to identify nerve bundles (nerve fibers surrounded by perineurium) in the excised zone II lesion. PGP9.5 nerve bundle density (bundles/high powered field [HPF]) was then scored by a pathologist blinded to the group. We found a significant difference in PGP9.5 nerve bundle density between the 3 groups (analysis of variance, F2,55 = 6.39, P = .003). Mean PGP9.5 nerve bundle density was significantly higher in the study group (1.16 ± 0.56 bundles/HPF [±standard deviation]) compared to control group 1 (0.65 ± 0.36, Tukey test, P = .005) and control group 2 (0.72 ± 0.56, Tukey test, P = .044). This study provides evidence that neurogenesis in the cul-de-sac/uterosacrals may be an etiological factor for deep dyspareunia in endometriosis.

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“…Several different surgical techniques are performed (Table 2), including excision/removal of endometriosis, uterosacral nerve ablation, presacral neurectomy, and hysterectomy with bilateral salpingo-oophorectomy (BSO) (Daniels et al 2010, Healey et al 2014, Posadzka et al 2015), and some techniques provide better symptomatic control than others. For symptom improvement and preventing disease recurrence, endometrioma removal is superior to drainage (Duffy et al 2014, Practice Committee of the American Society for Reproductive 2014).…”

Section: Treatmentsmentioning

confidence: 99%

Endometriosis: where are we and where are we going?

Greene¹,

Lang²,

Kendziorski³

et al. 2016

Reproduction

146

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Endometriosis currently affects ∼5.5 million reproductive-aged women in the U.S. with symptoms such as painful periods (dysmenorrhea), chronic pelvic pain, pain with intercourse (dyspareunia), and infertility. It is defined as the presence of endometrial tissue outside the uterine cavity and is found predominately attached to sites within the peritoneal cavity. Diagnosis for endometriosis is solely made through surgery as no consistent biomarkers for disease diagnosis exist. There is no cure for endometriosis and treatments only target symptoms and not the underlying mechanism(s) of disease. The nature of individual predisposing factors or inherent defects in the endometrium, immune system, and/or peritoneal cavity of women with endometriosis remains unclear. The literature over the last 5 years (2010-2015) has advanced our critical knowledge related to hormones, hormone receptors, immune dysregulation, hormonal treatments, and the transformation of endometriosis to ovarian cancer. In this review, we cover the aforementioned topics with the goal of providing the reader an overview and related references for further study to highlight the progress made in endometriosis research, while concluding with critical areas of endometriosis research that are urgently needed.

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To Excise or Ablate Endometriosis? A Prospective Randomized Double-Blinded Trial After 5-Year Follow-Up

Cited by 52 publications

References 9 publications

Retroperitoneal Anatomy during Excision of Pelvic Side Wall Endometriosis

Retroperitoneal Anatomy during Excision of Pelvic Side Wall Endometriosis

Nerve Bundles and Deep Dyspareunia in Endometriosis

Endometriosis: where are we and where are we going?

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