scholarly journals A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis

Endocrines ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 348-355
Author(s):  
Yoshiaki Ota ◽  
Kuniaki Ota ◽  
Toshifumi Takahashi ◽  
Yumiko Morimoto ◽  
So-Ichiro Suzuki ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Complete Removal ◽  
Posterior Wall ◽  
Complete Resection ◽  
Reproductive Age ◽  
High Recurrence Rate ◽  
Ureteral Stenosis ◽  
Deep Endometriosis ◽  
Pouch Of Douglas ◽  
Residual Lesions

Adenomyosis is commonly treated by total hysterectomy. Adenomyomectomy is considered for women of reproductive age who wish to preserve their fertility. However, a high recurrence rate following adenomyomectomy has been reported because complete removal of the lesion is difficult, and uterine rupture during pregnancy remains a complication. We previously reported that laparoscopic adenomyomectomy using a cold knife prevented thermal damage to the myometrium and elastography to avoid residual lesions. Here, we report the case of a patient who underwent complete resection of a subtype II adenomyosis and resection of deep endometriosis (DE) with the closure of the pouch of Douglas. The patient was 31 years old, had severe dysmenorrhea, and had left ureteral stenosis and subtype II adenomyosis associated with the closure of the pouch of Douglas by the DE. After resection of the DE posterior wall adenomyosis, residual lesions were confirmed by laparoscopic real-time elastography. Eight weeks after surgery, postoperative transvaginal ultrasound showed that the myometrium had shrunk from 28 to 22.7 mm, and the hydronephrosis had disappeared, although a stent remained necessary. In this study, we report the complete resection of subtype II adenomyosis and DE, combined with elastography to visualize the lesions during resection.

Extrinsic Venous Compression May Not Be a Sufficient Explanation for Venous Thromboembolism Due to Massive Fibroids.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4100-4100
Author(s):  
Sarah Barsam ◽  
Catherine N. Bagot ◽  
Raj K. Patel ◽  
Paul S. Sidhu ◽  
Anthony Davies ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Transvaginal Ultrasound ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Reproductive Age ◽  
Venous Stasis ◽  
Uterine Leiomyomata ◽  
Venous Compression ◽  
Extrinsic Compression

Abstract The relationship between uterine leiomyomata (fibroids) and venous thromboembolism (VTE) is poorly characterised. Fibroids are smooth muscle cell tumours of the uterus; occuring in approximately 40% of women of reproductive age, they are twice as prevalent in women from African compared to Caucasian origin. It is assumed that massive leiomyomata (palpable beyond the level of the umbilicus) cause deep vein thrombosis as a consequence of a direct compressive effect on pelvic veins but this explanation may be insufficient. Other hypotheses for the thrombogenic nature of leiomyomata include the abnormal expression of type 1 basic FGF receptor, increased expression of thrombospondin 1 and nitrogen oxide synthase, abnormal oestrogen regulation and fibroid-induced polycythaemia. We describe the cases of seven women (mean age 41 yrs, range 29–46yrs) with VTE presumed secondary to massive fibroids. The majority of women (86%) were of African or Carribbean origin. Massive uterine leiomyomata were demonstrated in each patient by transvaginal ultrasound scanning. All cases had objectively confirmed (duplex ultrasound) symptomatic DVT, and two had CT-confirmed symptomatic pulmonary embolism (PE) at presentation. Direct venous compression by massive fibroids was demonstrated in only one case using magnetic resonance imaging (MRI)(case 1). Interestingly the two cases with left sided proximal DVT (cases 2 and 5) revealed right-sided lateral and posterior uterine wall fibroids. Data on known acquired risk factors for VTE was recorded for each patient. Thrombophilia screening was performed in all cases at least four weeks following cessation of anticoagulation. Venous compression alone failed to explain six of the cases, where fibroids were not positionally related to the site of DVT. Of these, only one had significant additional risk factors for VTE (case 3). Whereas extrinsic compression of the pelvic veins may contribute to venous stasis and DVT formation in some cases, our findings suggest that it is unlikely that this is the only pathogenic mechanism. In conclusion, we suggest that the occurrence of VTE in women with massive fibroids is unlikely to be due solely to mechanical compression of the pelvic veins. It is possible that biological growth factors produced by the leiomyomata may trigger VTE formation and that oestrogen may have an independent growth promoting effect on both VTE and leiomyomata. Further research is required to characterise the prothrombotic state in these women. Patient Characteristics Ethnicity Site DVT D-dimer(mcg/l) Thrombophilia Risk Factors Fibroid Site Fibroid Size (mm) 1 Caribbean Left Proximal 1563 No No Left lateral wall 147 × 134 × 102 2 Caribbean Left Proximal 481 No No Posterior and right lateral wall and fundus 99 × 94 × 79 3 Caucasian Left Distal 969 Yes Flight, Previous DVT Posterior wall and fundus 89 × 77 4 African Right Proximal/PE 1883 No No Posterior wall 350 × 300 × 250 5 African Left Proximal 6152 No No Posterior and right lateral wall 136 × 124 × 124 6 African Right Proximal/PE N/A No No Multiple, widespread 60 × 58 × 73 7 Caribbean Right Proximal 2503 No No Right lateral wall 130×116

scholarly journals Transvaginal Ultrasound as a First-Line Approach in Deep Endometriosis: A Pictorial Essay

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 444
Author(s):  
Bogdan Doroftei ◽  
Radu Maftei ◽  
Ovidiu-Dumitru Ilie ◽  
Gabriela Simionescu ◽  
Emil Anton ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
First Line ◽  
Deep Endometriosis ◽  
Benign Condition ◽  
Hands On ◽  
Pictorial Essay ◽  
Optimal Approach ◽  
Fertile Women

Endometriosis (EMS) is a benign condition characterized by a systemic inflammation that affects fertile women at reproductive age. Ultrasound became, in recent years, the method of choice for both effective diagnostic and preoperative planning. Therefore, accurate characterization and mapping of endometriotic lesions is imperative in such circumstances to enable optimal approach of treatment, whether surgical or non-surgical based on the severity of the findings. This pictorial essay outlines a practical approach to evaluating patients with deep endometriosis by means of transvaginal ultrasound. The technical aspects are in conjunction with both consensus of the International Deep Endometriosis Analysis (IDEA) group and the hands-on experience acquired through daily clinical practice.

Innovative approaches to operational treatment of women of reproductive eligibility age with hyperplastic processes of the endometrium

2016 ◽  
pp. 41-45
Author(s):  
V.N. Goncharenko ◽  
Keyword(s):  
Endometrial Hyperplasia ◽  
Histopathological Examination ◽  
Intraoperative Complications ◽  
Transvaginal Ultrasound ◽  
Treatment Algorithm ◽  
Hormone Treatment ◽  
Endometrial Ablation ◽  
Reproductive Age ◽  
Dynamic Monitoring ◽  
Atypical Form

The aim of the study: was improvement of results of surgical treatment of patients of reproductive age eligibility with hyperplastic processes of endometrium (HPE) through the introduction of individualized treatment algorithm with the use of monopolar radio wave and hysteroscopic endometrial ablation. Materials and methods. The study included 62 women with non-atypical form of hyperplasia of the endometrium who were treated at the Center of General gynecology of the clinical hospital «Feofania», gynecological Department at the city maternity hospital № 3 of Kyiv. Depending on the age group, nature of the pathological process and method of treatment is randomized, the distribution of women according to groups: group 1 – 41 women's reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), who were subjected to hysteroscopic monopolar endometrial ablation; group 2 – 21 female reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), which was held radiowave ablation of the endometrium (RHAE). In the 1st group the age of patients ranged from 42 to 54 years, mean age was 49.9±4.7 years. In the 2nd group the age of patients ranged from 41 to 53 years, mean age of 51.6±4.3 years. Results. A comparative analysis of the techniques for hysteroscopic monopolar ablation and RHEE showed the fact that for RHEE used local anesthesia, while carrying out hysteroscopic monopolar ablation was necessary intravenous anesthesia. The duration of the hysteroscopic monopolar endometrial ablation was 28.6±5.5 min, RAE – according to the standard method – 44.3±0.3 min. When performing hysteroscopic monopolar endometrial ablation in 2 patients (3.7%) patients observed the signs of intravasation of fluid, increased blood pressure and tachycardia. This syndrome was successfully docked, but in the future, women have conducted a thorough examination. When you run RHAE intraoperative complications have been identified. Conclusion. 1. Women with netipichnaya forms of endometrial hyperplasia eligibility and late reproductive age who do not have reproductive plans as an alternative to hysterectomy, in the presence of contraindications or ineffectiveness of hormone treatment may be recommended or radiowave monopolar hysteroscopic ablation of the endometrium. 2. Monopolar hysteroscopic endometrial ablation is indicated for women with netipichnaya forms of endometrial hyperplasia, can be used in the presence of submucous form of uterine fibroids, postoperative scars on the uterus, but in the absence of adenomyosis II–III degree. The effectiveness of monopolar hysteroscopic endometrial ablation in women with non-atypical form of hyperplasia of the endometrium is 87.8%. 3. Women after endometrial ablation should be under observation for two years. The method of choice for dynamic monitoring of the condition of the uterus in women who underwent endometrial ablation is transvaginal ultrasound which should be performed after 1, 3, 6, 12 and 24 months of follow up. 4. In case of recurrence of hyperplastic process of the endometrium (bleeding, thickening of the M-mode echo according to the ultrasound) shows a hysteroscopy with a mandatory histopathological examination and verification of the diagnosis. Key words: endometrial hyperplasia, women eligibility age, women of reproductive age, ablation of the endometrium.

CLINICAL CASE OF SUCCESSFUL TREATMENT OF INFERTILITY IN A PATIENT WITH FAILURE IVF RESULTS IN ANAMNESIS

2020 ◽  
pp. 61-67
Author(s):  
Kalinkina O.B. ◽  
Tezikov Yu.V. ◽  
Lipatov I.S. ◽  
Aravina O.R.
Keyword(s):  
Assisted Reproductive Technologies ◽  
Transvaginal Ultrasound ◽  
Clinical Manifestations ◽  
Reproductive Function ◽  
Abnormal Uterine Bleeding ◽  
Clinical Situation ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Number Of Publications

Genital endometriosis is a disease of women of reproductive age, accompanied by infertility in 50% [1]. Adenomyosis can be considered as an endometriosis of the uterus. Histologically, this process is represented by ectopic, non-tumor endometrial glands, and stroma surrounded by hypertrophic and hyperplastic myometrium [2]. Adenomyosis is accompanied by pelvic pain of varying intensity as well as menstrual disorders [1]. The disease is accompanied by significant violations of reproductive function (infertility, unsuccessful attempts at pregnancy and miscarriage, abnormal uterine bleeding). Adenomyosis can be accompanied by a violation of the function of adjacent organs (such as the bladder, rectum). Often, one of the clinical manifestations of adenomyosis is the development of sideropenic syndrome, which is also caused by the development of chronic post-hemorrhagic iron deficiency anemia. This is accompanied by a deterioration in the general condition of patients, a decrease in their ability to work. Despite a large number of publications in Russian and foreign scientific sources devoted to this problem, reproductive doctors and obstetricians-gynecologists often underestimate the role of adenomyosis in pregnancy planning using assisted reproductive technologies. Without interpreting the anamnesis data obtained through an active survey, doctors do not prescribe additional methods for diagnosing this pathology, which is not complex and expensive. To confirm the diagnosis, a transvaginal ultrasound examination of the pelvic organs during the premenstrual period is sufficient. In cases that are difficult to diagnose, the MRI method of the corresponding anatomical area can be used. Underestimation of the clinical picture and under-examination of the patient did not allow prescribing timely correction of the pathology and led to unsuccessful attempts to implement the generative function using assisted reproductive technologies. The conducted examination with clarification of the cause of IVF failures and the prescribed reasonable treatment made it possible to achieve regression of endometriosis foci in this clinical situation, followed by the patient's ability to realize generative function.

scholarly journals Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis—a case-control study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Zahra Dehbashi ◽  
Shaheen Khazali ◽  
Fateme Davari Tanha ◽  
Farnaz Mottahedian ◽  
Mahsa Ghajarzadeh ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
Clinical Pregnancy ◽  
Reproductive Age ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
Double Blind ◽  
Entire Study

Abstract Background Endometriosis can exert obvious negative effects on women’s quality of life. Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods with a view to improving the quality of the treatments provided. Methods The present prospective double-blind randomized clinical trial was conducted on 50 women of reproductive age (≥ 19 years) diagnosed with severe pelvic endometriosis on transvaginal ultrasound scans and vaginal examinations at Yas Hospital between 2014 and 2017. Women with severe endometriosis (stage III, stage IV, and deep infiltrating endometriosis) requiring an extensive bilateral dissection of the pelvic walls and the rectovaginal space, with preserved uterus and ovaries, were included in the study. The preoperative severity of ovarian adhesions was assessed in terms of ovarian motility, measured through a combination of gentle pressures applied with the vaginal probe and abdominal pressures applied with the examiner’s free hand. A table of random numbers was used to choose which ovary to suspend. The entire study population received standard general anesthesia. In the laparoscopic examination of the cases with severe endometriosis, both ovaries were routinely suspended to the anterior abdominal wall with PROLENE sutures. At the end of the surgery, one of the ovaries was kept suspended for 7 days, whereas the other ovarian suspension suture was cut. At 3 months postoperatively, all the patients underwent ultrasound scans for the assessment of ovarian motility and adhesions. The severity of pelvic pain was defined according to a visual analog score. After surgery, infertile women were followed for 2-4 years, and were contacted regarding the infertility treatment. Chemical and clinical pregnancy rates was compered between the two groups. Results Three months after laparoscopy, the adhesions were mild in 41 (82%) patients and moderate in 9 (18%) on the suspended side, and mild in 12 (24%) patients and moderate in 38 (76%) on the control side (P < 0.001). The mean dysmenorrhea score was 6.8 ± 1.5 before surgery and 4.5 ± 1.4 after surgery (P < 0.001). The chemical pregnancy rate and clinical pregnancy rate were not different in the suspended and control groups (P = 0. 62, P = 0.64). Conclusions The reduction in adhesions via ovarian suspension surgery promises reductions in the complications of endometriosis.

scholarly journals Paraurethral Leiomyoma in a Postmenopausal Woman: First European Case

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Susy Shim ◽  
Camilla Skovvang Borg ◽  
Huda Galib Majeed ◽  
Peter Humaidan
Keyword(s):  
Smooth Muscle ◽  
Postmenopausal Woman ◽  
Smooth Muscle Cells ◽  
Postoperative Period ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Gynecological Examination ◽  
Urethral Pain ◽  
Paraurethral Leiomyoma

Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine.

scholarly journals Evaluation of transvaginal ultrasound role in the prediction of adenomyosis: correlation with histopathology

2021 ◽  
Vol 10 (8) ◽  
pp. 2987
Author(s):  
Naglaa Ali M. Hussein ◽  
Mohammed H. El Rafaey
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
True Positive ◽  
Women Of Reproductive Age ◽  
Presenting Symptoms ◽  
Us Findings ◽  
Histopathological Results ◽  
Symptoms And Signs

Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.

Sign in / Sign up

Export Citation Format

Share Document