Recurrent ureteral endometriosis
We present a case of a 31-year-old female with recurrent endometriosis after excision 5 years prior. Imaging was consistent with deep infiltrating endometriosis along the pelvic sidewall and this corresponded with surgical findings of a 1cm deep infiltrating endometriosis lesion extrinsic to the left ureter. It is crucial for the gynecologic surgeon to be familiar with ureteral endometriosis, its preferred treatment algorithm, and how to prevent recurrence. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: T Horton, A Carrubba Source Type: research
Excision of a vaginal cuff nodule in 9 steps
Endometriosis affects 6-10% of women and can have a serious impact on women ’s quality of life. While rare, endometriosis can occur at incisional sites following obstetric and gynecologic surgeries, such as cesarean section scars, port sites and the vaginal cuff. Endometriosis at the vaginal cuff occurs in 0.02% of cases. These lesions can cause pain, irregular bleeding, and dyspareunia, and the mainstay of treatment is surgical resection. Given that endometriosis at the vaginal cuff is a rare occurrence, many surgeons may not have experience performing the resection of a vaginal cuff nodule. (Source: American Journal of...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: V Buckley, B Malone, S Simko, S Handler, S Nahas, M Stuparich Source Type: research
Endometriosis of the bladder trigone: a fertility- sparing approach
Endometriosis can affect a variety of organs, including the urinary tract. Involvement of urinary structures occurs in 1-5% of endometriosis cases. Patients with urinary tract endometriosis can present with cyclic urinary frequency, dysuria, hematuria, urgency and pain with bladder distention. This video presents a 35-year-old nulliparous woman with dysmenorrhea, dysuria, urgency and pain with bladder distention. Pelvic MRI demonstrated uterine fibroids and deep infiltrating endometriosis invading the right pelvic sidewall and right bladder base involving the full thickness of the bladder near the right ureterovesical junc...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: T Muir, R Young, E Lin, J Gahan, K Kho Source Type: research
Minimally invasive approach to the excision of endometriosis from the abdominal wall, bladder, and pelvis
Extrapelvic endometriosis is a clinical entity in which implants of endometrial glandular tissue are found outside of the uterus and pelvis. Lesions are commonly associated with the abdominal wall, and patients may experience significant associated catamenial pain and bleeding at these sites. Safe surgical management often requires multidisciplinary planning with implementation of meticulous intraoperative technique to identify planes of dissection. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: C French, R Korets, E Gagliardi Source Type: research
Surgical management for endometriosis
A case of a 42 year old patient with cyclical pelvic pain, pain with intercourse, and dysmenorrhea with worsening characteristics is presented. The patient had already been treated for her pelvic pain based on a diagnosis by ultrasound of fibroids and an ovarian cyst with no improvement of her symptoms. On physical examination she had pain with palpation of the pelvic floor muscles, tenderness along ischial spines bilaterally, and tenderness along the posterior uterus. An MRI of the pelvis demonstrated endometriosis with visible lesions at the site of uterine retroflexion, along the right anterior uterus and a left ovarian...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: MJ Calero, A Carrubba Source Type: research
Ureterolysis for advanced endometriosis: principles and pearls for safe execution
Ureterolysis is typically required during resection of advanced endometriosis to keep the ureters safely distant during the procedure or to resect endometriosis involving the ureter itself. Proper technique is imperative to minimize the risk of ureteral injury. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: R Schneyer, K Hamilton, R Meyer, M Truong, K Wright, M Siedhoff Source Type: research
Preoperative factors associated with the diagnosis of adenomyosis and coexistent endometriosis at hysterectomy
Despite recent developments in imaging-based criteria for adenomyosis, early and accurate diagnosis is limited by heterogeneous symptomatology and frequent coexistence of other gynecologic pathologies. Delayed or misdiagnosis may be associated with inappropriate treatments, persistent symptoms, and reductions in quality of life. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: H Kyllo, C Mangham, G Whitmore, J Tam, K Hampanda, M Orlando Source Type: research
The effect of prophylactic antibiotic administration for endometriosis surgery
Endometriosis is commonly diagnosed and treated with laparoscopic surgery. Previous studies have found an association between endometriosis and pelvic infections, both prior to and after surgery. The pathogenic mechanisms leading to pelvic infection in patients with endometriosis may be the result of increased inflammatory state, alteration of pelvic microbiome, impaired immune response, and/or anatomy distortion favorable to bacteria proliferation. Currently, the American College of Obstetrics and Gynecology (ACOG) does not recommend antibiotic prophylaxis for laparoscopic procedures that do not include entry into the bow...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: K Work, R Meyer, R Schneyer, M Truong, K Wright, M Siedhoff Source Type: research
An analysis of body mass index and the risk of postoperative complications following colorectal resection for endometriosis
It is estimated that approximately 5-25% of women with endometriosis experience deep infiltrating endometriosis with colorectal involvement. Surgical options include bowel shaving, discoid excision, or segmental resection, and the majority of studies on the topic focus on these approaches. Currently, data are limited regarding the effect of BMI on surgical outcomes following colorectal resection for endometriosis. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: C Maxey, R Meyer, M Truong, K Wright, M Axelrod, Y Nasseri, M Barnajian, K Hamilton, R Schneyer, M Siedhoff Source Type: research
Integration of MRI for detection and surgical planning of advanced endometriosis
While physical examination, laboratory tests, and imaging have been used in the work-up of endometriosis, diagnostic laparoscopy with histopathology has long been used as the gold standard for endometriosis diagnosis. This method, however, has diagnostic limitations given variability of the appearance of lesions. Surgery also comes with potential patient complications and a high cost to the healthcare system. (Byrne, et al. 2018). A recent systematic review and meta-analysis revealed that ultrasound and MRI may be highly useful alternatives to laparoscopy for diagnosis of deep infiltrating endometriosis (Zhang et al. (Sour...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: T Gallant, C King, M Luna Russo, J Clay, J Hansen Source Type: research
Endometriosis-associated massive ascites in a young Nigerian lady
We report a 31-year-old nulligravida with progressive abdominal swelling, worsening dysmenorrhea, weight loss and a family history of ovarian tumour. Pelvic ultrasonography and Computed Tomography scans suggested an ovarian mass suspected to be an ovarian malignancy. Exploratory laparotomy revealed massive haemorrhagic ascites (8.6 litre) and multiple nodular masses on the anterior abdominal wall, omentum, bowel and pelvic organs, which were biopsied and confirmed on histopathology to be endometriosis. She had drainage of ascites and hormonal suppression using progestogen (Medroxyprogesterone acetate) with no recurrence in...
Source: Ghana Medical Journal - March 20, 2024 Category: African Health Authors: Abiodun S Adeniran Munirdeen A Ijaiya Kazeem O O Ibrahim Saidu Ibrahim Olaleke O Folaranmi Source Type: research
