A. Popov, I. Klyushnikov, A. Fedorov, A. Koval, S. Tyurina, A. Idashkin
Background: Sacrocolpopexy (SCP) is one of the most popular and approved surgical methods of correction of the apical pelvic organ prolapse (POP). This intervention has been adjusted to a laparoscopic approach for more than 20 years. Mini-invasive surgery’s advantages combined with dependable results of augmentation allowed to adopt it worldwide in most urogynecological wards. Nevertheless, SCP is not so basic in performance, so it can cause many difficulties during surgery, especially at first. This article describes step-by-step instruction of promontofixation performed either laparoscopically or robotically with the classic two-strap technique, focusing on anatomical landmarks and present our anatomical, and functional long-term outcomes covering up to 7 years of observation. Methods: Intervention could be divided into two big steps: (I) wide dissection and retroperitoneal tissue preparation combined with subtotal hysterectomy; (II) fixation of the mesh with non-absorbable sutures and peritoneal closure. During 2013–2020 years in Moscow Regional Scientific Research Institute of Obstetrics and Gynecology SCP was performed in 387 patients, 193 using laparoscopic approach and 194 robotic-assisted. For recurrence cases of POP, we took the criteria by International UroGynecological Association: direct or indirect genital prolapse reaching or going below the level of the hymen (POP-Q ≥ stage 2b) for objective recurrence. Functional outcomes were evaluated by international validated questionnaires by achieving the minimal clinical important difference (MCID) in points, previously approved by studies. Results: Our 3-year long-term outcomes resulted in 29 cases of POP recurrence (8.1%). Twenty-six of them were resulted in cystocele (7.3%), 4 (1.1%) in rectocele and 2 (0.6%) in apical prolapse. Clinical improvement based on Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) score was met in 132 (66.3%) patients, 250 (70.0%) of women improved pelvic floor dysfunction Pelvic Floor Distress Inventory-20 (PFDI-20) and 205 (57.4%) of patients improved their social life according to Pelvic Floor Inventory Questionnaire-7 (PFIQ-7) score. Conclusions: Our long-term results reflect, that this method may not be advised in cases with anterior-apical prolapse, because of the high risk for prolapse recurrence (7.3%) and surgical imperfection of safe and avascular dissection of the anterior vaginal wall. However, in patients with complex and posterior-apical prolapse, such intervention still should be considered as a “gold standard”. 8
{"title":"Sacrocolpopexy: anatomical landmarks, clinical appliance and 3-year outcomes","authors":"A. Popov, I. Klyushnikov, A. Fedorov, A. Koval, S. Tyurina, A. Idashkin","doi":"10.21037/gpm-21-18","DOIUrl":"https://doi.org/10.21037/gpm-21-18","url":null,"abstract":"Background: Sacrocolpopexy (SCP) is one of the most popular and approved surgical methods of correction of the apical pelvic organ prolapse (POP). This intervention has been adjusted to a laparoscopic approach for more than 20 years. Mini-invasive surgery’s advantages combined with dependable results of augmentation allowed to adopt it worldwide in most urogynecological wards. Nevertheless, SCP is not so basic in performance, so it can cause many difficulties during surgery, especially at first. This article describes step-by-step instruction of promontofixation performed either laparoscopically or robotically with the classic two-strap technique, focusing on anatomical landmarks and present our anatomical, and functional long-term outcomes covering up to 7 years of observation. Methods: Intervention could be divided into two big steps: (I) wide dissection and retroperitoneal tissue preparation combined with subtotal hysterectomy; (II) fixation of the mesh with non-absorbable sutures and peritoneal closure. During 2013–2020 years in Moscow Regional Scientific Research Institute of Obstetrics and Gynecology SCP was performed in 387 patients, 193 using laparoscopic approach and 194 robotic-assisted. For recurrence cases of POP, we took the criteria by International UroGynecological Association: direct or indirect genital prolapse reaching or going below the level of the hymen (POP-Q ≥ stage 2b) for objective recurrence. Functional outcomes were evaluated by international validated questionnaires by achieving the minimal clinical important difference (MCID) in points, previously approved by studies. Results: Our 3-year long-term outcomes resulted in 29 cases of POP recurrence (8.1%). Twenty-six of them were resulted in cystocele (7.3%), 4 (1.1%) in rectocele and 2 (0.6%) in apical prolapse. Clinical improvement based on Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) score was met in 132 (66.3%) patients, 250 (70.0%) of women improved pelvic floor dysfunction Pelvic Floor Distress Inventory-20 (PFDI-20) and 205 (57.4%) of patients improved their social life according to Pelvic Floor Inventory Questionnaire-7 (PFIQ-7) score. Conclusions: Our long-term results reflect, that this method may not be advised in cases with anterior-apical prolapse, because of the high risk for prolapse recurrence (7.3%) and surgical imperfection of safe and avascular dissection of the anterior vaginal wall. However, in patients with complex and posterior-apical prolapse, such intervention still should be considered as a “gold standard”. 8","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47522289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Ectopic implantation of endometrial tissues outside of the endometrial layer is termed as endometriosis, which affects almost 10% of childbearing women, and the onset of pathogenesis goes back to the first menstrual bleeding. The frequency is increased to 25–50% in women diagnosed with infertility. The existence of endometriosis negatively effects fertility by many different pathways, but its surgical treatment may also decrease the potential for fertility. The goal of endometrioma surgery is to remove the cyst without tissue remnants and preserve the ovarian reserve as much as possible. In case of endometriosis if surgical intervention is a must for women with endometriosis, oocyte collection and embryo freezing before surgical intervention is recommended. Surgical intervention after fertility preservation in endometriosis minimizes the stress of the patient and surgeons feel safer during the surgical intervention. In patients with endometriosis, the choice of expectant management or surgical intervention should be individualized. In cases where the chance of spontaneous conception is high, surgery remains the primary option for appropriate treatment. Laparoscopic surgery is the preferred method for surgical removal of endometriotic lesions and surgery should be performed by skilled and specially trained surgeons. Deciding about the modality of endometriosis treatment is a controversial issue and preservation of fertility in women with endometriosis is fundamental. Each patient must be evaluated individually according to their symptoms, severity, age, expectations, and risks. 6
{"title":"A narrative review of endometriosis surgery and infertility","authors":"U. Çoban, Ş. Hatırnaz, U. Kalkan","doi":"10.21037/GPM-20-55","DOIUrl":"https://doi.org/10.21037/GPM-20-55","url":null,"abstract":": Ectopic implantation of endometrial tissues outside of the endometrial layer is termed as endometriosis, which affects almost 10% of childbearing women, and the onset of pathogenesis goes back to the first menstrual bleeding. The frequency is increased to 25–50% in women diagnosed with infertility. The existence of endometriosis negatively effects fertility by many different pathways, but its surgical treatment may also decrease the potential for fertility. The goal of endometrioma surgery is to remove the cyst without tissue remnants and preserve the ovarian reserve as much as possible. In case of endometriosis if surgical intervention is a must for women with endometriosis, oocyte collection and embryo freezing before surgical intervention is recommended. Surgical intervention after fertility preservation in endometriosis minimizes the stress of the patient and surgeons feel safer during the surgical intervention. In patients with endometriosis, the choice of expectant management or surgical intervention should be individualized. In cases where the chance of spontaneous conception is high, surgery remains the primary option for appropriate treatment. Laparoscopic surgery is the preferred method for surgical removal of endometriotic lesions and surgery should be performed by skilled and specially trained surgeons. Deciding about the modality of endometriosis treatment is a controversial issue and preservation of fertility in women with endometriosis is fundamental. Each patient must be evaluated individually according to their symptoms, severity, age, expectations, and risks. 6","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46862507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.21037/GPM-2020-PFD-01
Victoria Wesevich, E. Webster, S. Baxley
: Minimally invasive surgery (MIS) has gained widespread use over the past several decades and is now the prevailing surgical approach within gynecology through utilization of hysteroscopy, cystoscopy, laparoscopy, and vaginal surgery. A minimally invasive technique offers a number of benefits to patients, including improved postoperative recovery and superior cosmetic outcomes, and is becoming an increasingly recognized essential skill for all gynecologists. With appropriate precautions and preoperative planning, MIS has been shown to be a safe and effective option for gynecologic procedures. Certain patient populations may present specific challenges to the minimally invasive surgeon. In this article, we discuss commonly encountered challenges in gynecologic MIS. Given the effect that laparoscopy and positioning may have on organ physiology, we review preoperative planning and optimization for medically complex patients. Additionally, we discuss the approach to surgically complex patients, such as those with obesity, pregnancy, prior surgeries with associated scarring and adhesions, and other anatomic abnormalities. As MIS continues to be a growing and evolving field, we highlight novel surgical technologies and discuss the learning curve associated with adoption of new techniques. Through surgeon preparedness and experience, common pitfalls within the field of MIS may be avoided and patients may be provided with optimal care.
{"title":"Overcoming challenges in minimally invasive gynecologic surgery","authors":"Victoria Wesevich, E. Webster, S. Baxley","doi":"10.21037/GPM-2020-PFD-01","DOIUrl":"https://doi.org/10.21037/GPM-2020-PFD-01","url":null,"abstract":": Minimally invasive surgery (MIS) has gained widespread use over the past several decades and is now the prevailing surgical approach within gynecology through utilization of hysteroscopy, cystoscopy, laparoscopy, and vaginal surgery. A minimally invasive technique offers a number of benefits to patients, including improved postoperative recovery and superior cosmetic outcomes, and is becoming an increasingly recognized essential skill for all gynecologists. With appropriate precautions and preoperative planning, MIS has been shown to be a safe and effective option for gynecologic procedures. Certain patient populations may present specific challenges to the minimally invasive surgeon. In this article, we discuss commonly encountered challenges in gynecologic MIS. Given the effect that laparoscopy and positioning may have on organ physiology, we review preoperative planning and optimization for medically complex patients. Additionally, we discuss the approach to surgically complex patients, such as those with obesity, pregnancy, prior surgeries with associated scarring and adhesions, and other anatomic abnormalities. As MIS continues to be a growing and evolving field, we highlight novel surgical technologies and discuss the learning curve associated with adoption of new techniques. Through surgeon preparedness and experience, common pitfalls within the field of MIS may be avoided and patients may be provided with optimal care.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48048838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endometriosis is defined as the presence of endometrial glands and stroma located outside the uterine cavity. Adenomyosis is a benign uterine disease, characterized by the presence of glands and endometrial stroma in the uterine musculature. Hysteroscopy is indicated in patients diagnosed with endometriosis when there is also infertility, in the investigation of intrauterine causes of dysmenorrhea and abnormal uterine bleeding. The investigation of the uterine cavity by hysteroscopy will only be indicated in cases where the treatment of choice leads to uterine preservation, if there is an indication for hysterectomy, this investigation will not be necessary, except when there is suspicion of cervical or endometrial cancer. Literature review on endometriosis and uterine manifestations. Personal and college libraries searching for texts on research methods and literature reviews. Hysteroscopy is indicated in patients diagnosed with endometriosis when there is also infertility, in the investigation of intrauterine causes of dysmenorrhea and abnormal uterine bleeding. Endometrial polyps, myomas and uterine malformations are related to endometriosis. Those entities are related to infertility, pelvic pain and abnormal uterine bleeding. Hysteroscopy is able to diagnose and treat the majority of uterine lesions associated to endometriosis. Chronic endometritis, Endometrial Polyps, Myomas and uterine malformations should be investigated by hysteroscopy in patients with endometriosis.
{"title":"Narrative review of hysteroscopy and endometriosis treatment","authors":"R. Lasmar, B. Lasmar","doi":"10.21037/GPM-2020-ES-01","DOIUrl":"https://doi.org/10.21037/GPM-2020-ES-01","url":null,"abstract":"Endometriosis is defined as the presence of endometrial glands and stroma located outside the uterine cavity. Adenomyosis is a benign uterine disease, characterized by the presence of glands and endometrial stroma in the uterine musculature. Hysteroscopy is indicated in patients diagnosed with endometriosis when there is also infertility, in the investigation of intrauterine causes of dysmenorrhea and abnormal uterine bleeding. The investigation of the uterine cavity by hysteroscopy will only be indicated in cases where the treatment of choice leads to uterine preservation, if there is an indication for hysterectomy, this investigation will not be necessary, except when there is suspicion of cervical or endometrial cancer. Literature review on endometriosis and uterine manifestations. Personal and college libraries searching for texts on research methods and literature reviews. Hysteroscopy is indicated in patients diagnosed with endometriosis when there is also infertility, in the investigation of intrauterine causes of dysmenorrhea and abnormal uterine bleeding. Endometrial polyps, myomas and uterine malformations are related to endometriosis. Those entities are related to infertility, pelvic pain and abnormal uterine bleeding. Hysteroscopy is able to diagnose and treat the majority of uterine lesions associated to endometriosis. Chronic endometritis, Endometrial Polyps, Myomas and uterine malformations should be investigated by hysteroscopy in patients with endometriosis.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45697503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Capozzi, G. Armano, V. Ceni, M. Ricco’, N. Volpe, R. Berretta
Ovarian cancer (OC) is the fifth most frequent cancer in Europe and currently represents the main cause of death in women presenting gynecological cancer. In 70% of cases, the disease may be diagnosed at an advanced stage with nonspecific symptoms. In the early stages OC, surgical staging is needed to assess the extent of the disease. According to the National Comprehensive Cancer Network (NCCN), surgical staging includes total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, and pelvic and lumboaortic lymphadenectomy. The classic surgical approach provides a median laparotomic longitudinal incision. However, in specialized centers, staging surgery may be performed through laparoscopic surgery for selected patients. Laparoscopic approach showed minor intra and postoperative complications, shorter hospital stay, faster return to work, and better aesthetic satisfaction when compared to laparotomic surgery. Nonetheless, even minimally invasive surgery is not without complications. In case of major complications occurring during laparoscopy rapid and prompt life-saving treatments could be necessary. We present a 63-year-old woman case with a 55 mm, multilocular-solid left adnexal mass, Color Score 2, with abnormal CA 125, requiring comprehensive staging surgery. The study aims to show a possible and dangerous vascular complication that may occur during staging lymphadenectomy in early-stage OC. In this case, a rapid laparotomic conversion was needed to quickly stop bleeding.
{"title":"Vascular complication during staging lymphadenectomy in early-stage ovarian cancer","authors":"V. Capozzi, G. Armano, V. Ceni, M. Ricco’, N. Volpe, R. Berretta","doi":"10.21037/gpm-20-26","DOIUrl":"https://doi.org/10.21037/gpm-20-26","url":null,"abstract":"Ovarian cancer (OC) is the fifth most frequent cancer in Europe and currently represents the main cause of death in women presenting gynecological cancer. In 70% of cases, the disease may be diagnosed at an advanced stage with nonspecific symptoms. In the early stages OC, surgical staging is needed to assess the extent of the disease. According to the National Comprehensive Cancer Network (NCCN), surgical staging includes total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, and pelvic and lumboaortic lymphadenectomy. The classic surgical approach provides a median laparotomic longitudinal incision. However, in specialized centers, staging surgery may be performed through laparoscopic surgery for selected patients. Laparoscopic approach showed minor intra and postoperative complications, shorter hospital stay, faster return to work, and better aesthetic satisfaction when compared to laparotomic surgery. Nonetheless, even minimally invasive surgery is not without complications. In case of major complications occurring during laparoscopy rapid and prompt life-saving treatments could be necessary. We present a 63-year-old woman case with a 55 mm, multilocular-solid left adnexal mass, Color Score 2, with abnormal CA 125, requiring comprehensive staging surgery. The study aims to show a possible and dangerous vascular complication that may occur during staging lymphadenectomy in early-stage OC. In this case, a rapid laparotomic conversion was needed to quickly stop bleeding.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/gpm-20-26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41454821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. McKee, Kayla A. Carter, C. Bassis, V. Young, B. Reed, D. Harper, M. Ruffin, J. Bell
Background: The relationship between the vaginal microbiota, high-risk human papillomavirus infection, and abnormal cervical cytology has not been well characterized. Our objective was to characterize the vaginal microbiota in a stratified random sample of women from a population-based study in Appalachia. Methods: We analyzed a random sample of 308 women in the Community Access, Resources and Education: Project 3 study across 16 clinics in Ohio and West Virginia. Using Illumina MiSeq sequencing of 16S rRNA gene amplicons, we characterized the vaginal microbiota among (I) 109 women randomly chosen with abnormal cervical cytology (i.e., the majority were atypical squamous cells of undetermined significance (n=55) and low-grade squamous intraepithelial lesions (n=45) while n=6 were high-grade squamous intraepithelial lesions and n=3 were atypical glandular cells); (II) 110 high-risk human papillomavirus infection only without cytologic abnormality; and (III) 89 women from a stratified random sample without cytologic abnormalities (negative for intraepithelial lesion or malignancy or any human papillomavirus infection). Among the women with abnormal cervical cytology (n=109), 80 had human papillomavirus infection, the majority of which were positive for a high-risk type (n=61). Results: Nearly all of the women were non-Hispanic White (94.5%), and the mean age was 26 (IQR=21–39) years. Women with abnormal cervical cytology or who were HPV+ were more likely to have a diverse vaginal microbiota characterized by higher Gardnerella vaginalis relative abundance, compared to women without cytologic abnormalities whose communities were more likely to be Lactobacillus spp. dominant (P<0.04). Women without cytologic abnormalities had a higher prevalence of L. iners dominated communities than women with abnormal cervical cytology and HR HPV+ respectively (P<0.04), and L. gasseri relative abundance was differentially greater among these women compared to women with abnormal cervical cytology or who were high-risk HPV+ (Linear discriminant analysis effect size =4.17; P=0.0009). After adjustment for age, white race, current smoking, and ≥2 male partners in the last year, however, we did not detect differences in the vaginal microbiota community states across the three outcome groups. Conclusions: Compared to women without cytologic abnormalities, the vaginal microbiota of women with abnormal cervical cytology or who were high-risk HPV+ were characterized by a diverse community with increased relative abundance of G. vaginalis and reduced relative abundance of L. gasseri. However, these differences were attenuated after adjustment for other factors. Further study and validation of these differences for prognostic use is warranted.
{"title":"The vaginal microbiota, high-risk human papillomavirus infection, and cervical cytology: results from a population-based study","authors":"K. McKee, Kayla A. Carter, C. Bassis, V. Young, B. Reed, D. Harper, M. Ruffin, J. Bell","doi":"10.21037/gpm-20-10","DOIUrl":"https://doi.org/10.21037/gpm-20-10","url":null,"abstract":"Background: The relationship between the vaginal microbiota, high-risk human papillomavirus infection, and abnormal cervical cytology has not been well characterized. Our objective was to characterize the vaginal microbiota in a stratified random sample of women from a population-based study in Appalachia. Methods: We analyzed a random sample of 308 women in the Community Access, Resources and Education: Project 3 study across 16 clinics in Ohio and West Virginia. Using Illumina MiSeq sequencing of 16S rRNA gene amplicons, we characterized the vaginal microbiota among (I) 109 women randomly chosen with abnormal cervical cytology (i.e., the majority were atypical squamous cells of undetermined significance (n=55) and low-grade squamous intraepithelial lesions (n=45) while n=6 were high-grade squamous intraepithelial lesions and n=3 were atypical glandular cells); (II) 110 high-risk human papillomavirus infection only without cytologic abnormality; and (III) 89 women from a stratified random sample without cytologic abnormalities (negative for intraepithelial lesion or malignancy or any human papillomavirus infection). Among the women with abnormal cervical cytology (n=109), 80 had human papillomavirus infection, the majority of which were positive for a high-risk type (n=61). Results: Nearly all of the women were non-Hispanic White (94.5%), and the mean age was 26 (IQR=21–39) years. Women with abnormal cervical cytology or who were HPV+ were more likely to have a diverse vaginal microbiota characterized by higher Gardnerella vaginalis relative abundance, compared to women without cytologic abnormalities whose communities were more likely to be Lactobacillus spp. dominant (P<0.04). Women without cytologic abnormalities had a higher prevalence of L. iners dominated communities than women with abnormal cervical cytology and HR HPV+ respectively (P<0.04), and L. gasseri relative abundance was differentially greater among these women compared to women with abnormal cervical cytology or who were high-risk HPV+ (Linear discriminant analysis effect size =4.17; P=0.0009). After adjustment for age, white race, current smoking, and ≥2 male partners in the last year, however, we did not detect differences in the vaginal microbiota community states across the three outcome groups. Conclusions: Compared to women without cytologic abnormalities, the vaginal microbiota of women with abnormal cervical cytology or who were high-risk HPV+ were characterized by a diverse community with increased relative abundance of G. vaginalis and reduced relative abundance of L. gasseri. However, these differences were attenuated after adjustment for other factors. Further study and validation of these differences for prognostic use is warranted.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/gpm-20-10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47833662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ureteral endometriosis is a rare location of this medical condition, found in 0.01% to 1% of all women diagnosed with the disease. Ureteral endometriosis can be a major concern due to its potential morbidity of silent loss of renal function. Deep infiltrative endometriosis (DIE) can be safely dealt with using robotic assistance. This video article is about a patient with a right low ureter stenosis caused by intrinsic endometriosis. Complete resection of endometriosis, including en-bloc resection of the lower part of the ureter was performed with robotic assistance. A robotically assisted ureteroneocystostomy by the LeadbetterPollitano technique was carried out for the reconstructive part of the procedure.
{"title":"Robotic assistance for ureteral endometriosis resection and ureteroneocystostomy by the Leadbetter-Politano technique","authors":"T. Hébert, B. D'Arcier","doi":"10.21037/gpm-20-2","DOIUrl":"https://doi.org/10.21037/gpm-20-2","url":null,"abstract":"Ureteral endometriosis is a rare location of this medical condition, found in 0.01% to 1% of all women diagnosed with the disease. Ureteral endometriosis can be a major concern due to its potential morbidity of silent loss of renal function. Deep infiltrative endometriosis (DIE) can be safely dealt with using robotic assistance. This video article is about a patient with a right low ureter stenosis caused by intrinsic endometriosis. Complete resection of endometriosis, including en-bloc resection of the lower part of the ureter was performed with robotic assistance. A robotically assisted ureteroneocystostomy by the LeadbetterPollitano technique was carried out for the reconstructive part of the procedure.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46194235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endometriosis is a chronic condition determined by the presence of ectopic endometrial glands and stroma. The disease affects approximately 10% of women of reproductive age and 35-50% of women with chronic pelvic pain and/or infertility. Transvaginal ultrasonography is a very sensitive and specific instrument for the diagnosis of endometrioma. Surgical and/or medical therapies for endometriomas aim to control symptoms (in particular, chronic pelvic pain and dysmenorrhea) and prevent cyst growth; medical therapy may be employed to reduce recurrence rate after surgery. After surgical approach, the reported postoperative recurrence rate of endometriomas is high, ranging from 30% to 40%; therefore, several hormonal therapies, such as oral contraceptives (OC), progestins (PG), GnRH analogs (GnRHa), and antagonists, danazol, aromatase inhibitors, selective estrogen receptor modulators (SERMs) and selective progesterone receptor modulators (SPRMs), have been employed in order to prevent disease recurrence. The objective of this systematic review is to assess the impact of the adjuvant use of hormonal treatment on endometrioma recurrence. Two evaluators extracted from MEDLINE, EMBASE, and Cochrane Library and reviewed published studies on this topic, following pre-determined selection criteria. Finally, data were extracted from 16 selected prospective or retrospective studies, of which 8 were randomized controlled trial and 8 were cohort studies. Most of them reported a beneficial impact on endometrioma recurrence by the usage of OC, PG, and GnRH analogs (GnRHa); however, conflicting results exist in the current literature about this topic. The duration of adjuvant therapy seems to have a crucial role in this context, but it is still not clear which type of postoperative hormonal treatment represents the best choice.
{"title":"Hormonal treatments for preventing recurrence of endometriomas","authors":"G. D’Alessandro, F. Barra, M. Tantari, S. Ferrero","doi":"10.21037/gpm-20-23","DOIUrl":"https://doi.org/10.21037/gpm-20-23","url":null,"abstract":"Endometriosis is a chronic condition determined by the presence of ectopic endometrial glands and stroma. The disease affects approximately 10% of women of reproductive age and 35-50% of women with chronic pelvic pain and/or infertility. Transvaginal ultrasonography is a very sensitive and specific instrument for the diagnosis of endometrioma. Surgical and/or medical therapies for endometriomas aim to control symptoms (in particular, chronic pelvic pain and dysmenorrhea) and prevent cyst growth; medical therapy may be employed to reduce recurrence rate after surgery. After surgical approach, the reported postoperative recurrence rate of endometriomas is high, ranging from 30% to 40%; therefore, several hormonal therapies, such as oral contraceptives (OC), progestins (PG), GnRH analogs (GnRHa), and antagonists, danazol, aromatase inhibitors, selective estrogen receptor modulators (SERMs) and selective progesterone receptor modulators (SPRMs), have been employed in order to prevent disease recurrence. The objective of this systematic review is to assess the impact of the adjuvant use of hormonal treatment on endometrioma recurrence. Two evaluators extracted from MEDLINE, EMBASE, and Cochrane Library and reviewed published studies on this topic, following pre-determined selection criteria. Finally, data were extracted from 16 selected prospective or retrospective studies, of which 8 were randomized controlled trial and 8 were cohort studies. Most of them reported a beneficial impact on endometrioma recurrence by the usage of OC, PG, and GnRH analogs (GnRHa); however, conflicting results exist in the current literature about this topic. The duration of adjuvant therapy seems to have a crucial role in this context, but it is still not clear which type of postoperative hormonal treatment represents the best choice.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47761938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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