Background: The purpose of the study was to determine the quality of life in patients with bowel endometriosis before and after laparoscopic bowel resection. Material and methods: In the ...retrospective study we included 91 patients who underwent laparoscopic resection of the bowel affected by endometriosis at the Unit for Reproduction and the Unit for Gynecology, Department of Obstetrics and Gynecology Ljubljana, in the period from 2002 to 2011. The study was retrospective. The patients were sent a questionnaire regarding the symptoms before surgery and the effect of surgery on bowel symptoms, painful menstruation, painful sexual intercourse, chronic pelvic pain and quality of life before and after surgery; 76 (83.5 %) patients replied to the questionnaire. Results: Before surgery, 72 (94.7 %) patients reported painful menstruation. Improvement or complete relief after surgery was registered in 57 (79.1 %). Out of 60 (78.9 %) patients who had painful sexual intercourse before surgery, 49 (81.7 %) reported improvement or complete relief after surgery. Bowel symptoms, present in 52 (68.4 %) patients before surgery, improved or completely disappeared in 48 (92.4 %) after surgery. Chronic pelvic pain, present in 53 (69.7 %) before surgery, decreased or did not exist any more in 45 patients (86.5 %). The quality of life before surgery was very poor in 32 patients (42.1 %), and poor in 21 patients (27.8 %). After the operation, the quality of life was reported as improved in 22 (28.9 %) and signicantly improved in 42 (55.3 %). Conclusions: Laparoscopic bowel resection, indicated in extensive symptomatic endometriosis, signicantly improves the patients quality of life.
MOLECULAR BASIS OF ENDOMETRIOSI Tina Šmuc; Martina Ribič Pucelj; Tea Lanišnik Rižner
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
08/2008, Letnik:
77, Številka:
8
Journal Article
Recenzirano
Odprti dostop
BACKGROUND Endometriosis is defined as the presence of endometrial glands and stroma within extrauterine sites. Estimations show that up to 15 % of women in their reproductive age areaffected. ...Extrauterine endometrial tissue can be found on the pelvic peritoneum, on theovaries, in the rectovaginal septum, and more rarely, in the pericardium and pleura forming three different entities: peritoneal endometriosis, ovarian endometriosis and deependometriotic nodules of the rectovaginal septum. Symptoms for endometriosis may include painful and/or heavy periods, pain during intercourse, pelvic pain, 30–50 % reducedfertility and low back pain. Pathogenesis of endometriosis is not yet fully understood. It iswell known that endometriosis is an estrogen-dependent disease, with distinctive genetic,immunological and environmental risk factors. CONCLUSIONS The review focuses on different cell processes which are disturbed in endometriosis patients. A better understanding of the molecular basis of endometriosis will aid in identification of molecular markers and novel drug targets in the future, providing better diagnostics and treatment
Background. Endometriosis is nowadays probably the most frequent cause of infertility or subfertility and is revealed in approximately 30–40% of infertile women. The association between fertility and ...minimal or mild endometriosis remains unclear and controversial. Moderate and severe forms of the disease distort anatomical relations in the minor pelvis, resulting in infertility. The goals of endometriosis treatment are relief of pain symptoms, prevention of the disease progression and fertility improvement. Treatment of stages I and II endometriosis (according to the R-AFS classification) may be expectative, medical or surgical. In severely forms of the disease (stage III and IV) the method of choice is surgical treatment. Combined medical and surgical treatment is justified only in cases, in which the complete endometriotic tissue removal is not possible or recurrence of pain symptoms occur. Nowadays, laparoscopic surgical treatment is the golden standard being the diagnostic and therapeutic tool during the same procedure. The aim of this study was to evaluate the fertility rate after surgical treatment of different stages of endometriosis.Patients and methods. In prospectively designed study 100 infertile women were included. The only known cause of infertility was endometriosis. In group A there were 51 patients with stage I and II endometriosis, whereas in group B there were 49 patients with stage III and IV of the disease. Endometriosis was diagnosed and treated laparoscopically. Endometriotic implants were removed either with bipolar coagulation or CO2 laser vaporisation, whereas adhesions were sharp or blunt dissected, and endometriomas stripped out of ovaries. Pregnancy rates were calculated for both groups of patients, and statistically compared between the groups.Results. Mean age of patients was 29.25 (SD ± 4.08) years and did not significantly differ between the groups of patients (29.5 years in group A and 29 years in group B). In group A 31 (60.8%) out of the 51 patients conceived spontaneously within 24 months after surgery. In group B 30 (61.2%) out of the 49 patients conceived spontaneously after surgery. The difference in pregnancy rates between the groups was not statistically significant.Conclusions. Surgical treatment of endometriosis in infertile patients is by all means effective and most appropriate, although some have not confirmed its value in patients with minimal or mild endometriosis comparing it with the no-treatment protocol. The limitations of this study should be considered. The main drawback is its design: the trial was not a randomised controlled one. We advocate that endometriosis once diagnosed must be surgically treated, to prevent progression of the disease at least. Endometriosis appears to progress in two-thirds of patients within a year from the diagnosis, and it is impossible to predict, in which patients it will progress. It would be unethical, and even unprofessional not to remove even the smallest endometriotic implants when the disease is confirmed by laparoscopy.
Background: The aim of the research was to determine the success of laparoscopic myomectomy (LM), frequency of recurrence of broids following the treatment and possible risk factors for recurrence. ...Methods: Retrospective research was used. We included 455 females who underwent LM in the period from January 2003 until December 2006 at the Ljubljana Gynaecologic Clinic (Clinical Department of Reproduction). The data were collected from the analysis of questionnaires sent to the females in 2010 to their postal addresses. Results: The questionnaire was completed by 297 (65.3 %) females, 6 questionnaires were excluded from further analysis due to incomplete answers. From those questioned 197 (67.7 %) women had abnormal uterine bleeding and 156 (53.6 %) had pain before surgery. Uterine bleeding was normalised aer the surgery in 168 cases (85.3 %) and pain was reduced or stopped completly in 135 cases (86.5 %). The surgery fullled expectations of 257 (88.3 %) females. A broid recurred in 98 (33.7 %) cases, on average 25.1 (296) months aer the procedure, 40 (40.8 %) females underwent repeat surgery. As for risk factors for broid recurrence following LM, the number of removed broids proved to be statistically signicant (p = 0.026), while the impact of age was not statistically signicant (p = 0.77). Conclusions: Given that the probability of broid recurrence and repeat surgery increases with the number of removed broids in the rst operation, it may be appropriate for women with multiple broids who have completed their fertility period to propose one of the methods of hysterectomy, in particular, minimally invasive laparoscopic supracervical or total hysterectomy, which are increasingly well established.
BACKGROUND Advances in the diagnosis and treatment of malignancies in girls and young women had significantly increased survival rates, but surgical removal of the ovaries, potentially sterilizing ...radiotherapy or chemotherapy often result in premature ovarian failure, infertility and premature menopause. The degree of ovarian damage depends on the gonadotoxicity of chemotherapeutic agent and radiation dose, while surgical removal of the ovaries results in irreversible loss of ovarian function. Recently, with the purpose of fertility preservation, on one side, less radical surgical procedures in early stages of cancer are performed while on the other, advances in laboratory techniques in in vitro fertilization enable cryopreservation of own genetic material. CONCLUSIONS While cryopreservation of embryos and oocytes is already an established and successful procedure, ovarian transplantation - despite reports of livebirths following the transplantation - still remains at experimental stage. The indication for fertility preservation should take into account type of cancer, prognosis of the disease, age (≤ 38 let), planned therapy, such as type of surgical procedure, gonadotoxicity of chemotherapeutic agents and irradiation dose, and therefore cooperation of oncologists, reproductive gynecologists and embryologists is mandatory, because each indication must be carefully taken into consideration.
Background. The aim of this retrospective study was to find the incidence and type of adnexal masses in pregnancy, reliability of preoperative ultrasound examination and the effect of the surgical ...approach used, duration of pregnancy at the time of surgery, and the effect of emergency or planned surgery on the outcome of pregnancy. The obtained results and the data from literature were to provide the basis of the guidelines for the management of pregnant women with adnexal masses.Methods. In the study we enrolled 42 women, who underwent a surgery in pregnancy for adnexal masses. All surgeries were performed at the Department of Obstetrics and Gynecology in the period 1 January 1993–31 August 2000. The course of pregnancy was followed by 28 February 2001. The data were obtained from the records kept at the Department and from the questionnaire sent to the women. Statistical analysis was done using Chi-square test. Statistical significance was set at P ≤ 0.05.Results. We found the incidence of adnexal masses in pregnancy, requiring surgical treatment, to be 1/1034 deliveries. There were 6 (14.3%) borderline malignant and malignant ovarian tumours, the incidence being 1/7239 deliveries. Preoperative ultrasound examination was not reliable enough to differentiate neither between benign and malignant adnexal masses, nor between adnexal masses and leiomyomas. Forty-two surgeries were made, 21 by laparoscopy and 21 by laparotomy. The size of removed tumours ranged between 4 and 30 cm (mean 9.4 cm), the most frequent type was mature cystic teratoma (n = 12). There were no differences in the outcome of pregnancy between the laparoscopy and laparotomy approach, between emergency and planned surgery, and between laparotomy performed by the 23rd and after the 23rd gestational week. Hemorrhagic shock due to heterotopic pregnancy lead to 1 spontaneous abortion. There were 2 preterm deliveries in the 37th week, 2 babies had intrauterine growth retardation, and 1 congenital malformations.Conclusions. The incidence of adnexal masses found in this study resembles that found in literature. Laparoscopic surgery is at least as safe as laparotomy. Surgery performed in the first trimester of pregnancy did not increase the risk of worse outcome of pregnancy. A relatively high percentage of borderline malignant and malignant tumours and not enough sensitive ultrasound examination justify the use of invasive diagnostic and surgical treatment of adnexal masses in pregnancy, especially after laparoscopy has become extensively used. Tumours are recommended to be removed laparoscopically after the 12th gestational week, because in this period the removal of the ovary and corpus luteum is not dangerous, the effect of anesthetics on the fetus during organogenesis is avoided, and the uterine size is still appropriate for a safe procedure. For a relatively small number, the management of these cases is recommended to be carried out in centres with appropriate equipment and experience in laparoscopic management of adnexal masses.
Background. In women with spontaneous abortions, preterm deliveries or infertility, septate uterus is often detected on transvaginal ultrasound examination. Since 1993 we have used hysteroscopic ...resection to correct this anomaly. The aim of this study was to evaluate the effect of the arcuate uterus on the course of pregnancy and its outcome, and the effect of hysteroscopic resection of the arcuate uterus on the prognosis of pregnancy.Patients and methods. Retrospectively we analyzed prospectively collected data. Between 15 February 1993 and 31 December 1999 we performed 760 hysteroscopic resections of the septum at the Department of Obstetrics and Gynecology in Ljubljana. We evaluated the course of pregnancy and its outcome only, therefore we enrolled 241 women, who conceived spontaneously before and after operation.Results. In the group of women with arcuate uterus (n = 111) there were 244 pregnancies before hysteroscopic resection: 38 (15.6%) ended with a delivery and 202 (82.8%) with a spontaneous abortion. In the group of women with septate uterus (n = 130) there were 269 pregnancies: 42 deliveries (15.6%) and 224 (83.3%) spontaneous abortions. After hysteroscopic resection there were 109 pregnancies in the women with arcuate uterus: 91 (83.5%) deliveries and 16 (14.7%) spontaneous abortions; in the septate uterus group there were 118 pregnancies: 98 (83.2%) deliveries and 16 (13.5%) spontaneous abortions. In both groups there was a significant improvement in the delivery rate (p < 0.00000). Before resection the preterm delivery rates were significantly higher in both groups (arcuate: 50.0%; septate: 35.1%) than after the resection (arcuate: 11.3%; septate 17.7%).Conclusions. The women with either septate or arcuate uterus are at a higher risk for spontaneous abortion and preterm delivery. Hysteroscopic resection significantly decreases the risk in both groups of women.
The automated gravitational Vario Flow system with weighing-based electronic fluid deficit indicator was used in order to reduce the risk of fluid intravasation during continuous flow hysteroscopic ...procedures. Early experiences are reported.
Between August 1996 and July 1997, the Vario Flow with fluid deficit indicator and alarm system was used in 203 hysteroscopic operations. Between January 1994 and August 1996 the Vario Flow without fluid deficit indicator was used in 240 hysteroscopic operations. In all, there were 443 hysteroscopic operations: 301 metroplasties, 20 endometrial ablations, 10 cases of lysis of synechiae, 58 myomectomies and 54 polypectomies. The data on fluid deficit before and after the introduction of the electronic fluid deficit indicator were similar.
Fluid deficit indicator was proved highly efficient in 203 operations. It provided the information on fluid deficit at any moment during hysteroscopic operations. Besides intrauterine pressure, the actual fluid deficit has become one of the leading parameters during our continuous flow hysteroscopic procedures.
We therefore conclude that by using an automated gravitational system with fluid deficit indicator and alarm system, the safety for patients during hysteroscopic procedures has been increased.
Background. Polycystic ovaries (PCO) are manifested either independently or as a syndrome (PCOS). They are one of the commonest endocrinopathy in women of reproductive age. Despite a variable ...clinical picture one of the leading symptoms is infertility for anovulation. Surgical treatment of the disease witnessed a revival after the introduction of minimally invasive operative laparoscopy. Various techniques of ovarian tissue destruction have been applied, the most common being laparoscopic electrocoagulation of the ovaries (LECO). The aim of this retrospective study was to assess the pregnancy rates and pregnancy outcomes following LECO.Patients and methods. From 1993 and 2000 inclusive LECO was performed at the Reproductive Unit, Department of Obstetrics and Gynecology Ljubljana in 222 infertile patients with PCO(S), in whom previous medical ovulation induction failed or in whom overreaction of the ovaries to gonadotropin treatment occurred. To the questionnaire, mailed to the patients, 185 (83.3%) responded. The evaluation of the outcome of LECO treatment involved 157 patients, since the patients who underwent in vitro fertilization (IVF-ET) treatment for other causes of infertility prior to LECO, were exclude from the analysis. LECO was performed under general endotracheal anesthesia using a 3-puncture technique. On each ovary 5– 15 (mean 10) punctures were made with a monopolar electric needle, energy of 300 W, and duration of 4 seconds. Statistical analysis was done using Chi-square test and odds ratios.Results. After LECO 99 (63.3%) of the 157 patients conceived, 56 (54.6%) spontaneously and 43 (45.4%) after additional postoperative ovarian stimulation. Pregnancy was registered in 58 (59.0%) patients with primary, and in 41 (41%) patients with secondary infertility, in 20 (57%) patients with PCO, 79 (65%) with PCOS, in 71 (64.1%) patients with a normal partner’s spermiogram, and in 28 (46.1%) patients with the partner’s oligoasthenoteratospermia of the 1st or 2nd degree. The differences were not statistically significant. Pregnancy ended with delivery in 87 (88.1%) patients, and in spontaneous abortion in 11 (11%); 1 (0.9%) pregnancy was ectopic. Singletons were born to 82 (82.9%) and twins to 5 (5.2%) patients, the latter to the patients receiving ovarian stimulation immediately after surgery. In the patients, enrolled in IVF-ET treatment for a failed hormonal and/or surgical treatment, the delivery rate per ET was 23.4% (19/48) in those with a previous LECO, and 12.9% (36/115) in those without a previous LECO (p < 0.05). No surgical complications were registered.Conclusions. LECO is an efficient treatment of infertility in patients with PCO(S). It results in high pregnancy and low spontaneous abortion rates, and reduces the risk of ovarian hyperstimulation syndrome following gonadotropin treatment.
Background. We designed the study to determine the frequency of perimenopausal symtoms among women in Slovenia and the need for their treatement.Methods. In the research 578 women aged 45–54 years ...were included during their visit at one of 24 participating outpatient department clinics for women’s health in Slovenia. The women were interwieved by one of 31 gynecologists participating in the study.Results. The mean age of women was 49.6 years. Almost a half (48%) have still had regular periods, 29% were postmenopausal. The median age at menopause was 52.4 years. The major perimenopausal features were nervouseness (72%), anxiety (64%), sweating (63%), insomnia (60%) and headache (56%), less frequent were stomach pressure (35%), skin changes (32%) and dispareunia (24%). One-fifth (21%) of women were smokers (smokers had lower age at menopause as non-smokers, p = 0.01). One third (39%) currently took analgetics, 19% antihypertensives, 16% tranquillisers and 22% hormonal replacement therapy (HRT). The majority (81%) of women on HRT have found the HRT effects positive or very positive.Conclusions. The high rate of perimenopausal features among perimenopausal women in Slovenia deserves special attention. The study has also shown that the use of HRT is justified when indicated.
