Pag. 20

J Lab Physicians. 2010 Jul;2(2):117-20.

Incisional endometriosis: diagnosed by fine needle aspiration cytology.

Veda P, Srinivasaiah M.

Source

Department of Pathology, India.

Abstract

Incisional endometriosis (IE) is a rare entity reported in 0.03-1.08% of women following obstetric or gynecologic surgeries. Most cases reported in literature have appeared after cesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. We hereby report a case of IE following a second trimester hysterotomy, which was diagnosed by fine needle aspiration cytology (FNAC). Our patient was 26 years old, presenting with a mass over anterior abdominal wall, associated with incapacitating pain during each menstrual cycle. FNAC showed epithelial cells, stromal cells and hemosiderin laden macrophages. Based on the typical history, clinical and cytological features, the diagnosis of IE was established. Wide surgical excision was done and the resulting rectus sheath defect was repaired. Patient was followed for 6 months during which time she was symptom free. This article also reviews the spectrum of cytological features and the rare possibility of malignant transformation that can occur in IE.

Obstet Gynecol. 2011 Mar;117(3):727-8.

Gonadotrophin-releasing hormone analogues for pain associated with endometriosis.

Gilliam ML.

Source

University of Chicago, Department of Obstetrics and Gynecology, 5841 South Maryland Avenue, MC 2050, Chicago, IL 60637, USA. mgilliam@babies.bsd.uchicago.edu

Comment on

Hum Reprod. 2011 May;26(5):1104-11. Epub 2011 Feb 20.

The addition of GnRH antagonists in intrauterine insemination cycles with mild ovarian hyperstimulation does not increase live birth rates–a randomized, double-blinded, placebo-controlled trial.

Cantineau AE, Cohlen BJ, Klip H, Heineman MJ; Dutch IUI Study Group Collaborators.

Collaborators (11)

Hoek A, Lambalk CB, Hamilton CJ, Van Bommel PF, van Dop PA, van der Heijden PF, de Sutter P, D’Hooghe T, Manger PA, Ombelet W, Santema JG.

Source

Department of Gynecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands. aepcantineau@gmail.com

Abstract

BACKGROUND:

This multicenter, double-blinded RCT investigated the efficacy of GnRH antagonists in cycles with mild ovarian hyperstimulation (MOH) followed by IUI in subfertile women.

METHODS:

Couples diagnosed with unexplained, male factor subfertility or associated with the presence of minimal or mild endometriosis were randomized with a computer-generated list of numbers by a third party in a double-blinded setting to receive either a GnRH antagonists or a placebo in 12 institutional or academic hospitals. All women were treated with recombinant FSH in a low-dose step-up regimen starting on Day 2-4 of the cycle. A GnRH antagonist was added when one or more follicles of 14 mm diameter or more were visualized. When at least one follicle reached a size of ≥18 mm, ovulation was induced by hCG injection. A single IUI was performed 38-40 h later. Couples were offered a maximum of three consecutive cycles. The primary outcome of the trial was live births. Secondary outcomes were pregnancy rates, multiple pregnancy rates, miscarriages and ovarian hyperstimulation syndrome rate.

RESULTS:

A total of 233 couples were included from January 2006 to February 2009, starting 572 treatment cycles. Live birth rates were not significantly different between the group treated with GnRH antagonist (8.4%; 23/275) and the placebo group (12%; 36/297) (P = 0.30). Three twin pregnancies occurred in the GnRH antagonist group and two twin pregnancies in the placebo group.

CONCLUSIONS:

Adding a GnRH antagonist in cycles with MOH in an IUI program does not increase live birth rates. Dutch Trial Register no: NTR497.

Am Surg. 2011 Feb;77(2):239-41.

Bowel endometriosis as an unusual cause of rectal bleeding.

González-Pezzat I, Soto-Pérez-de-Celis E, García-Lascurain JL.

Source

Hospital Angeles Pedregal, Mexico City, Mexico.

ChemMedChem. 2011 Mar 7;6(3):476-87. doi: 10.1002/cmdc.201000457. Epub 2011 Feb 17.

Bicyclic substituted hydroxyphenylmethanone type inhibitors of 17 β-hydroxysteroid dehydrogenase Type 1 (17 β-HSD1): the role of the bicyclic moiety.

Oster A, Klein T, Henn C, Werth R, Marchais-Oberwinkler S, Frotscher M, Hartmann RW.

Source

Pharmaceutical and Medicinal Chemistry, Saarland University, & the Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus C2 3, P.O. Box 151150, 66123 Saarbrücken, Germany.

Abstract

An attractive target that has still to be explored for the treatment of estrogen-dependent diseases, such as breast cancer and endometriosis, is the enzyme responsible for the last step in the biosynthesis of estradiol (E2): 17β-hydroxysteroid dehydrogenase type 1 (17β-HSD1). It catalyzes the reduction of the weakly active estrone (E1) into E2, which is the most potent estrogen in humans. Inhibition of 17β-HSD1 lowers intracellular E2 concentrations and thus presents a therapeutic target for estrogen-dependent pathologies. Recently, we reported a new class of highly active and selective 17β-HSD1 inhibitors: bicyclic substituted hydroxyphenylmethanones. Here, further structural variations on the bicyclic moiety are described, especially focusing on the exchange of its hydroxy function. Twenty-nine novel inhibitors were synthesized and evaluated for 17β-HSD1 inhibition in a cell-free and cellular assay, for selectivity toward 17βHSD2 and estrogen receptors (ER) alpha and beta, as well as for metabolic stability. The best compound exhibited IC50 values of 12 nM (cell-free assay) and 78 nM (cellular assay), high selectivity for 17β-HSD1, and reasonable metabolic stability. A molecular docking study provided insight into the protein-ligand interactions of this compound with 17β-HSD1.

Eur Radiol. 2011 Jul;21(7):1553-63. Epub 2011 Feb 19.

Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography.

Scardapane A, Bettocchi S, Lorusso F, Stabile Ianora AA, Vimercati A, Ceci O, Lasciarrea M, Angelelli G.

Source

Department of Internal Medicine and Public Health (Di.M.I.M.P.)-Section of Diagnostic Imaging, University Hospital “Policlinico”, Piazza Giulio Cesare 11, 70124 Bari, Italy. a.scardapane@radiologia.uniba.it

Abstract

OBJECTIVE:

To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis.

METHODS:

One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years’ experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded.

RESULTS:

MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen’s K test).

CONCLUSION:

CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.

Hum Reprod. 2011 May;26(5):1082-90. Epub 2011 Feb 18.

microRNAs expression in endometriosis and their relation to angiogenic factors.

Ramón LA, Braza-Boïls A, Gilabert-Estellés J, Gilabert J, España F, Chirivella M, Estellés A.

Source

Research Center, Hospital Universitario La Fe, Valencia, Spain.

Abstract

BACKGROUND:

Endometriosis is a common, multifactorial disease in which angiogenesis may be involved in the growth of endometrium outside the uterus. microRNAs (miRNAs) are 21-22 nucleotide non-coding RNAs that regulate gene expression and play fundamental roles in biological processes. The objective of this study was to analyze several miRNAs related to angiogenesis and the angiogenic factors, vascular endothelial growth factor-A (VEGF-A) and thrombospondin-1 (TSP-1), in endometriotic lesions (ovarian endometrioma, peritoneal lesion and rectovaginal nodule) and eutopic endometrium from women with endometriosis.

METHODS:

TaqMan real-time PCR was used to assess the expression of the miRNAs (miR-15b, -16, -17-5p, -20a, -21, -125a, -221 and -222), while VEGF-A and TSP-1 mRNA were assessed by real-time PCR, with SYBR Green I and VEGF-A and TSP-1 protein levels were quantified by ELISA. Included in the study were 58 women with endometriosis and 38 control women.

RESULTS:

In paired samples, ovarian endometrioma showed significantly lower VEGF-A mRNA (P = 0.02) and protein (P = 0.002) expression than eutopic endometrium and higher expression of miR-125a (P = 0.003) and miR-222 (P <0.001). However, ovarian endometrioma had significantly higher expression of the angiogenic inhibitor TSP-1 and lower expression of miR-17-5p than eutopic endometrium (P < 0.001). Moreover, a significant inverse correlations between miR-222 and VEGF-A protein levels (-0.267, P = 0.018) and between miR-17-5p and TSP-1 protein levels (-0.260, P=0.022) were observed. Peritoneal lesions showed a significant increase in VEGF-A in comparison with ovarian endometrioma (P < 0.01).

CONCLUSIONS:

Expression levels of miRNAs related to angiogenesis were different in eutopic endometrium from that observed in ovarian endometrioma. This could influence the expression of angiogenic factors and play a role in the pathogenesis of endometriosis.

Fertil Steril. 2011 Jun 30;95(8):2772-4. Epub 2011 Feb 19.

Nerve fibers and menstrual cycle in peritoneal endometriosis.

Wang G, Tokushige N, Fraser IS.

Source

Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China.

Abstract

There was no difference in the density of nerve fibers across the menstrual cycle in peritoneal endometriotic lesions. These findings may explain why patients with peritoneal endometriosis often have painful symptoms throughout the menstrual cycle.

Int J Gynaecol Obstet. 2011 May;113(2):116-9. Epub 2011 Feb 18.

Vaginal danazol for women with rectovaginal endometriosis and pain symptoms persisting after insertion of a levonorgestrel-releasing intrauterine device.

Ferrero S, Tramalloni D, Venturini PL, Remorgida V.

Source

Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa, Italy. dr@simoneferrero.com

Abstract

OBJECTIVE:

To evaluate the effectiveness of treatment with vaginal danazol in improving the pain symptoms caused by rectovaginal endometriosis that persist after insertion of a levonorgestrel-releasing intrauterine device (LNG-IUD).

METHODS:

This pilot observational study included 15 women with rectovaginal endometriosis and pain symptoms persisting after LNG-IUD insertion. Vaginal danazol (100mg per day) was self-administered for 6months. The intensity of pain symptoms and the volume of rectovaginal endometriotic nodules were evaluated.

RESULTS:

Twelve women were satisfied or very satisfied with the treatment. After treatment with vaginal danazol for 3months, there was a significant decrease in the intensity of pain symptoms compared with their intensity before the administration of danazol. The intensity of pain symptoms decreased further at 6-month follow-up. The volume of the rectovaginal nodules decreased after treatment with vaginal danazol for 6months (1.7±0.8cm(3)) compared with the baseline volume (2.3±0.9cm(3); P<0.001). Adverse effects of the treatment were minimal and well tolerated.

CONCLUSION:

Although a placebo effect cannot be excluded, the results indicate that vaginal danazol decreases the severity of endometriosis-related pain symptoms after LNG-IUD insertion.

Fertil Steril. 2011 Apr;95(5):1560-7.e1-3. Epub 2011 Feb 21.

Proteolytic tailoring of the heat shock protein 70 and its implications in the pathogenesis of endometriosis.

Chehna-Patel N, Warty N, Sachdeva G, Khole V.

Source

Department of Gamete Immunobiology, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Parel, Mumbai, India.

Abstract

OBJECTIVE:

To investigate the mechanism underlying the appearance of a 20-kd HSP70 fragment and its consequences in the ectopic endometrium of endometriosis patients.

DESIGN:

Experimental study.

SETTING:

Research institute and obstetrics and gynecology clinic.

PATIENT(S):

Participants with (n = 18) and without (n = 20) endometriosis.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Reverse-transcription polymerase chain reaction, protease assays, and in silico tools were used to investigate the origin of the 20-kd HSP70 fragment. Immunocolocalization studies were carried out to determine whether subtilisin/kexin isozyme 1 (SKI-1) and HSP70 are colocalized. Expression and localization of surrogate markers of inflammation, such as nuclear factor NF-κB and interleukin IL-6 were examined by immunoblotting and in situ studies.

RESULT(S):

HSP70 is posttranslationally processed into a 20-kd fragment by SKI-1, a protease of the subtilisin family, in ectopic endometrium (ECE). Immunocolocalization studies revealed spatial proximity of SKI-1 and HSP70 in ECE. Furthermore, ECE demonstrated nuclear localization of the transcription factor, NF-κB and high expression of its target protein, IL-6.

CONCLUSION(S):

This study hints at the possible mechanisms underlying the trimming of HSP70 in ECE and also at the role of proteases in the pathogenesis of endometriosis. The possible repercussions of HSP70 fragmentation include dysregulation of key regulatory proteins, resulting in the escalation of inflammatory events in endometriotic lesions.

Cir Esp. 2011 Feb 17. [Epub ahead of print]

Inguinal endometriosis of the round ligament.

[Article in English, Spanish]

Silberman EA, Quildrian SD, Vigovich FA, Porto EA.

Source

Servicio de Cirugía General, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.

Photodiagnosis Photodyn Ther. 2011 Mar;8(1):58-63. Epub 2011 Jan 13.

Photodiagnosis and photodynamic therapy of endometriotic epithelial cells using 5-aminolevulinic acid and steroids.

Wołuń-Cholewa M, Szymanowski K, Nowak-Markwitz E, Warchoł W.

Source

Department of Cell Biology, Poznan University of Medical Sciences, Poznan, Poland. doskon@ump.edu.pl

Abstract

BACKGROUND:

The photodynamic diagnosis and therapy represent relatively new methods used, i.a., in the detection of some preneoplastic and neoplastic conditions. They are based on selective accumulation of photosensitizers in the altered cells, which can be identified by fluorescence of the sensitizers and, using light of an appropriate wavelength, can be eliminated. Currently, investigations continue on application of the methods in diagnosis and therapy of endometriosis, one of the most prevalent causes of a reduced fertility in women.

METHODS:

In this study protoporphyrin IX, a photosensitizer derived from 5-aminolevulinic acid, was used to locate and destroy endometrial epithelium. Material for the investigations involved primary epithelial cells, isolated from 15 normal endometria and 15 ovarian endometriotic epithelia. Taking into account the cyclical hormonal alterations, which affect endometrial cells in individual phases of the menstrual cycle, experiments were conducted on accumulation of the photosensitizer and photodestruction of the cells preceded by their hormonal stimulation (17β-estradiol and progesterone).

RESULTS AND CONCLUSION:

It was found that following 48 h stimulation with 17β-estradiol and/or progesterone a significantly augmented synthesis of protoporphyrin IX can be obtained in cells of endometrial epithelium as compared to the normal epithelium. Moreover, the endometriotic epithelial cells were most effectively eliminated following 48 h prestimulation with progesteron alone. The obtained result permits to assume that photodynamic diagnosis and photodynamic therapy of endometrial epithelium should be performed in the secretory phase of endometrium in order to optimise their results.

Vopr Kurortol Fizioter Lech Fiz Kult. 2010 Sep-Oct;(5):28-30.

Combined application of interference therapy and “dry” carbon dioxide baths for the treatment of hemodynamic disorders in patients with implantation failure due to inflammation.

[Article in Russian]

sokolova IuIu, Silant’eva ES, Serov VN.

Abstract

This work was designed to evaluate the influence of different physiotherapeutic modalities on the possibility of implantation, development and outcome of pregnancy in patients with chronic endometriosis and previous failures of implantation. The study confirmed initial sonographic changes and deficit of uterine blood supply as well as gradual improvement of these parameters under effect of adequate physiotherapy. Inclusion of dry carbon dioxide baths in the combined treatment of hemodynamic disorders made it possible to “prepare” endometrium for implantation and optimize blood circulation in the uterine vasculature in order to enhance the probability of implantation, development of pregnancy, and its success.

Biol Reprod. 2011 Jun;84(6):1242-7. Epub 2011 Feb 16.

Cigarette smoke increases progesterone receptor and homeobox A10 expression in human endometrium and endometrial cells: a potential role in the decreased prevalence of endometrial pathology in smokers.

Zhou Y, Jorgensen EM, Gan Y, Taylor HS.

Source

Department of Obstetrics, Gynecology and Reproductive Sciences, Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Abstract

Cigarette smoking has long been tied to a multitude of poor health outcomes; however, in reproductive biology, smoking has shown several unintuitive findings. Smoking is associated with significantly decreased rates of endometriosis and endometrial cancer. Here, we show that treatment with cigarette smoke extract leads to increased mRNA and protein expression of homeobox A10 (HOXA10) and progesterone receptor (PGR) as well as more rapid decidualization of endometrial stromal cells in vitro. In vivo, mice exposed to cigarette smoke similarly showed increased expression of HOXA10 and PGR in the endometrium. Both HOXA10 and PGR drive endometrial differentiation and are suppressed in endometrial tumors and in endometriosis. The increased expression found upon exposure to cigarette smoke may provide a protective effect, mediating the decreased incidence of endometrial disease among smokers. This mechanism contrasts with the accepted paradigm that the effects of smoking on the uterus are secondary to ovarian alterations rather than direct effects on endometrium as demonstrated here.

Clin Transl Oncol. 2011 Feb;13(2):71-6.

The role of iron in tumour cell proliferation.

Steegmann-Olmedillas JL.

Source

Department of Hematology, Hospital Universitario de La Princesa, Madrid, Spain. jlsteegmann.hlpr@salud.madrid.org

Abstract

Iron has a pivotal role in homeostasis due to its participation in virtually all of the body’s oxidation-reduction processes. However, iron can also be considered a double-edged weapon, as its excess may lead to an increased risk of developing cancer, presumably by the generation of reactive oxygen species, and its role as substrate to enzymes that participate in cell proliferation. Thus, iron might as well be considered a cofactor in tumour cell proliferation. In certain pathological conditions, such as haemochromatosis, hepatitis B and C virus infection, asbestosis and endometriosis, iron overload may increase the risk of cancer. By contrast, iron depletion could be considered a useful adjunct in antitumour therapy. This paper reviews the current scientific evidence behind iron’s role as a protumoral agent, and the potential benefit of a state of iron depletion in patients with cancer.

Fertil Steril. 2011 Jun 30;95(8):2655-7. Epub 2011 Feb 16.

The steroidogenic factor-1 protein is not expressed in various forms of endometriosis but is strongly present in ovarian cortical or medullary mesenchymatous cells adjacent to endometriotic foci.

Noël JC, Anaf V, Borghese B, Vaiman D, Fayt I, Chapron C.

Source

Department of Gynecopathology, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.

Abstract

Steroidogenic factor-1 (SF-1) protein expression was not observed in any form of endometriosis (peritoneal, ovarian, or deep infiltrating endometriosis), which suggests that SF-1 locally produced by endometrial or stromal cells may not play a major role in the development of endometriosis. However, the strong expression of SF-1 in cortical and medullary ovarian mesenchymatous cells may be capable of creating a favorable steroidogenic environment and the development of the disease.

Eur J Gynaecol Oncol. 2010;31(6):719-21.

Grade 2 endometrioid adenocarcinoma arising from adenomyosis of the uterus: report of a case.

Kazandi M, Zeybek B, Terek MC, Zekioglu O, Ozdemir N, Oztekin K.

Source

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey. mert.kazandi@ege.edu.tr

Abstract

Adenomyosis is defined by the presence of endometrial tissue (glands and stroma) within the myometrium and malignant transformation of adenomyosis in premenopausal women with normal endometrium is extremely rare. Adenocarcinomas arising within adenomyosis need to be distinguished from endometrial carcinomas which arise from the eutopic endometrium, then extend into preexisting adenomyosis of the uterine wall. We report a case of grade 2 endometrioid adenocarcinoma arising from an adenomyotic focus in the uterus.

Eur J Gynaecol Oncol. 2010;31(6):621-6.

Reliability of oupatient endometrial brush cytology vs biopsy in postmenopausal symptomatic women.

Mossa B, Ebano V, Marziani R.

Source

Department of Gynecological Sciences, Perinatology and Child Health, II School of Medicine, University of Rome “La Sapienza”, Division of Obstetrics and Gynecology, Sant’Andrea Hospital, Rome, Italy. bruno.mossa@uniroma1.it

Abstract

OBJECTIVE:

To compare outpatient endometrial sampling cytology with conventional biopsy in postmenopausal women with abnormal uterine bleeding and/or abnormal endometrial thickness at ultrasound.

METHOD:

Between December 2003 and December 2009 a group of 1,056 postmenopausal women was referred to the Department of Gynecological Sciences, Perinatology an Child Health II Faculty of Medicine, University of Rome, S.Andrea Hospital. Four hundred and eighty-two patients (45.6%) had abnormal uterine bleeding and 602 (57.0%) showed an endometrial thickness > 5 mm at ultrasound. Patients on hormonal therapy (n = 194) including hormonal replacement therapy (HRT) or tamoxifen (TMX), were enrolled in the study. Endometrial cytologic sampling was performed using a brush device (EBC) while endometrial histological sampling was retrieved using a Novak curette. Histologic evaluation showed: a) malignant neoplasia b) atypical hyperplasia c) benign pathology d) normal or atrophic endometrium. The following points were investigated: a) failure in performing a procedure for cervical stenosis or pelvic pain; b) nondiagnostic specimens; c) diagnostic accuracy.

RESULTS:

Evidence in score pain differences between brush and curette endometrial samples were observed: 50% of patients undergoing brush cytology had lower pain scores (chi-square = 288.33; p = .001), whereas 60% of patients undergoing endometrial biopsy had higher pain scores (chi-square = 264.84; p = .001). The failure rate in performing procedures was 8.0% vs 4.1%, and the results were statistically significant on the McNemar test, respectively p = .01 and p = .001. A nondiagnostic specimen was obtained in 3.9% of cases by EBC, and 10.3% of cases by the Novak curette (p = .001). Cytological evaluation had a sensitivity of 100%, specificity of 99%, positive and negative predictive value of 97% and 100% for diagnosing malignant neoplasia. Cytology had high diagnostic accuracy for atypical hyperplasia: sensitivity 100%, specificity 99%, positive and negative predictive value 83% and 100%, respectively.

CONCLUSIONS:

EBC is a reliable, well tolerated outpatient diagnostic tool for endometrial sampling in detecting early-stage cancer in postmenopausal patients at high risk for endometrial cancer.

Urologia. 2010 Oct-Dec;77 Suppl 17:16-9.

Indications and limits to endourologic procedures for endometriosis of the urinary tract.

[Article in Italian]

Marino G, Piras D, Pedalino M, Di Primio OG, Vella R, Vercesi E.

Source

SC Urologia, SC Anatomia Patologica ASL T0 5 Chieri (Torino), Italy. tanomarino@libero.it

Abstract

INTRODUCTION:

The incidence of Urinary tract endometriosis (UTE) ranges from 1% to 3%; bladder is the most affected organ (85% of UTE), followed by ureter (12 – 14% of UTE), for which we distinguish an intrinsic very rare form and an extrinsic variety most frequently occurring in advanced pelvic endometriosis.

MATERIALS AND METHODS:

From 1997 to 2010, 33 surgical procedures for urologic endometriosis were performed, involving the urinary tract, in 28 patients with mean age of 31 years (25-43). The localization of endometriosis were: 7 cases in the bladder, 2 cases in the vesicoureteral tract, and 19 cases of ureteral tract only. Of these, two cases were diagnosed with an intrinsic localization.

RESULTS:

Overall, we performed 3 TURB, 5 partial cystectomies (2 with open surgical approach and 3 by laparoscopy procedure), 12 laparoscopic ureterolysis and simultaneous protection of the upper urinary tract with stent, 9 cases of ureterocystoneostomy (UCNS) according to Lich-Gregoire procedure, and 3 according to Boari-Kuess procedure. Of the 12 patients who underwent ureterolysis with laparoscopic and stenting procedure, five cases required a UCNS according to Lich-Gregoire technique for persistent ureteral obstruction.

CONCLUSIONS:

The limits of endoscopic procedures in endometriosis of the urinary tract are correlated both to the degree of extension and the localization of the disease. It is mandatory to achieve an interdisciplinary consensus in order to ensure the disease removal and the simultaneous functional results of the upper urinary tract.

Urologia. 2010 Oct-Dec;77 Suppl 17:12-5.

Endometriosis: necessary and sequential therapeutic procedures and guidelines.

[Article in Italian]

Jasonni VM.

Source

Università di Modena e Reggio Emilia, Italy. vjasonni@libero.it

Abstract

OBJECTIVES:

To define the actual guidelines about the therapy of endometriosis.

METHODS:

A brief review of the literature for the correct diagnosis of endometriosis and the medical and surgical approach.

RESULTS:

It is well accepted that the gold standard of endometriosis diagnosis is the direct vision of the disease with laparoscopy or the presence of endometriosis implants in vagina or cervix. Staging must be performed along with the distribution, and depth and bowel involvement must be noted. Symptoms intensity is not related to the degree of endometriosis. Therapy, medical or surgical, should be chosen in relation to symptoms and the disease degree, keeping in mind that surgery is the approach that may offer better results.

CONCLUSIONS:

The direct vision of the disease is the only method to obtain the correct diagnosis and an accurate staging. However, ultrasound can be helpful in cases of pelvic localization and in the follow-up of the disease. Moreover, MRI can be employed, especially in cases with particular endometriosis implant, e.g. gluteus muscle. Surgery offers the best results but some medical therapy, especially hormonal therapy, is often employed for the relief of pains.

Urologia. 2010 Oct-Dec;77 Suppl 17:1-11.

Endometriosis: aetiopathogenetic basis.

[Article in Italian]

Larosa M, Facchini F, Pozzoli G, Leone M, Grande M, Monica B.

Source

UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla, Italy. larosa@ausl.re.it

Abstract

Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common condition affecting 10% of women in the reproductive age. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. The theory of retrograde menstruation with implantation of endometrial fragments, in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted. There is a growing body of evidence that immunological factors and angiogenesis play a key role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes, with production of growth factors and inflammatory mediators in the peritoneal fluid. Survival, adhesion, proliferation, invasion and vascularization of endometrial tissue in abdominal cavity may be the consequence of retrograde menstruation and referred to as implantation theory.

 

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