Parametrial endometriosis with ureteral involvement: A case report of a conservative approach without ureteral resection

2018 ◽  
Vol 10 (4) ◽  
pp. 222-223 ◽  
Author(s):  
Paolo Donarini ◽  
Giuseppe Ciravolo ◽  
Fabio Rampinelli ◽  
Franco Odicino ◽  
Federico Giorgio Ferrari ◽  
...  
Keyword(s):  
Renal Function ◽  
Uterosacral Ligament ◽  
Deep Infiltrating Endometriosis ◽  
Conservative Approach ◽  
Left Ureter ◽  
Stent Removal ◽  
Preoperative Work Up ◽  
Work Up ◽  
Infiltrating Endometriosis

Introduction: Parametrial endometriosis could often involve the ureter and periureteral tissue causing hydronephrosis and distortion of the normal ureteral course and position. The treatment in the case of hydronephrosis could be ureterolysis (with or without the positioning of a stent) or a ureteral resection. Materials and methods: This is the case of left parametrial endometriosis with hydronephrosis in a young woman. The preoperative work-up showed a deep infiltrating endometriosis of the left parametria, the left uterosacral ligament, and the left ureter which caused hydronephrosis. The patient was symptomatic (dysmenorrhea, dysuria, and pelvic pain). In this video, we focused on ureterolysis: all the endometriotic tissues were removed, the ureter was completely released, and the decision was to place a stent in the ureter without ureteral resection. Results: The post-operative course was normal, the stent was changed after 1 week (from mono-J to double-J) and removed 1 month after surgery. Follow-up at 3 and 8 months after stent removal was normal, and renal function was normal. The last follow-up, after 13 months, showed no hydronephrosis, no signs of deep infiltrating endometriosis, and normal renal function. The patient continues with oral contraception. Conclusion: Ureterolysis could be an effective alternative to ureteral resection in cases of deep infiltrating endometriosis even when the ureter is involved with hydronephrosis.

Understanding pre-operative staging and surgical practice in advanced endometriosis: A survey of Canadian gynaecologists

2020 ◽  
Vol 12 (3-4) ◽  
pp. 134-141
Author(s):  
Andra Nica ◽  
Grace Y. Liu ◽  
Amanda Selk ◽  
Jamie Kroft
Keyword(s):  
Transvaginal Ultrasound ◽  
Uterosacral Ligament ◽  
Management Plan ◽  
Deep Infiltrating Endometriosis ◽  
Advanced Stage ◽  
Web Based ◽  
Study Objective ◽  
Survey Tool ◽  
Operative Evaluation ◽  
Infiltrating Endometriosis

Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist.

Rectosigmoid deep infiltrating endometriosis and ureteral involvement with loss of renal function

2012 ◽  
Vol 162 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Jose L. Muñoz ◽  
Jesus S. Jiménez ◽  
Alvaro Tejerizo ◽  
Gregorio Lopez ◽  
Jose Duarte ◽  
...  
Keyword(s):  
Renal Function ◽  
Deep Infiltrating Endometriosis ◽  
Infiltrating Endometriosis

Dyspareunia in women with deep infiltrating endometriosis of the uterosacral ligament

2004 ◽  
Vol 82 ◽  
pp. S161-S162
Author(s):  
S. Ferrero ◽  
F. Esposito ◽  
L.H. Abbamonte ◽  
P. Anserini ◽  
V. Remorgida ◽  
...  
Keyword(s):  
Uterosacral Ligament ◽  
Deep Infiltrating Endometriosis ◽  
Infiltrating Endometriosis

Long-term follow-up after ureteral reimplantation in patients with severe deep infiltrating endometriosis

2013 ◽  
Vol 171 (1) ◽  
pp. 146-149 ◽  
Author(s):  
Ron Schonman ◽  
Zohar Dotan ◽  
Adi Y. Weintraub ◽  
Mordechai Goldenberg ◽  
Daniel S. Seidman ◽  
...  
Keyword(s):  
Deep Infiltrating Endometriosis ◽  
Ureteral Reimplantation ◽  
Long Term Follow Up ◽  
Infiltrating Endometriosis

Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up

2017 ◽  
Vol 69 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Pietro Cignini ◽  
Salvatore Giovanni Vitale ◽  
Antonio Simone Laganà ◽  
Antonio Biondi ◽  
Valentina Lucia La Rosa ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Definition Of ◽  
Preoperative Work Up ◽  
Work Up ◽  
Early Stage Endometrial Cancer

Deep Infiltrating Endometriosis: Making the Diagnosis

2019 ◽  
Vol 35 (6) ◽  
pp. 511-513
Author(s):  
Elliot M. Levine ◽  
Carlos M. Fernandez ◽  
Maggie Pham ◽  
Abraham Shashoua ◽  
Stephen Locher
Keyword(s):  
Diagnostic Laparoscopy ◽  
Signs And Symptoms ◽  
Uterosacral Ligament ◽  
Transvaginal Sonography ◽  
Deep Infiltrating Endometriosis ◽  
Diagnostic Ability ◽  
The Right ◽  
Infiltrating Endometriosis

A case is described of a patient who presented with signs and symptoms suggestive of endometriosis. She underwent a diagnostic laparoscopy, which failed to identify any features of endometriosis. The patient subsequently underwent a 3D transvaginal sonogram that demonstrated evidence of a deep infiltrating endometriosis, affecting the right uterosacral ligament. This case demonstrates the diagnostic ability of 3D transvaginal sonography and, at the same time, the potential deficiency of laparoscopy to make the diagnosis of deep infiltrating endometriosis.

Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team

2019 ◽  
Vol 11 (3) ◽  
pp. 152-157
Author(s):  
Julie Poujois ◽  
Cécile Mézan De Malartic ◽  
Ronan Callec ◽  
Laurent Bresler ◽  
Nicolas Hubert ◽  
...  
Keyword(s):  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Robotic Assistance ◽  
Deep Endometriosis ◽  
Surgical Assistance ◽  
Surgical Data ◽  
The Mean ◽  
Infiltrating Endometriosis

Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.

scholarly journals Primary endometrioid carcinoma of the uterosacral ligament arising from deep infiltrating endometriosis 6 years after bilateral salpingo-oophorectomy due to atypical proliferative endometrioid tumor of the ovary: a rare case report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Yoshiaki Ota ◽  
Kuniaki Ota ◽  
Toshifumi Takahashi ◽  
Soichiro Suzki ◽  
Rikiya Sano ◽  
...  
Keyword(s):  
Ovarian Tumor ◽  
Rare Case ◽  
Malignant Tumors ◽  
Uterosacral Ligament ◽  
Pelvic Lymphadenectomy ◽  
Borderline Ovarian Tumor ◽  
Deep Infiltrating Endometriosis ◽  
Endometrioid Carcinoma ◽  
Ovarian Endometrioma ◽  
Infiltrating Endometriosis

Abstract Background Endometriosis can potentially lead to the development of a malignant tumor. Most malignant tumors arising from the endometriosis originate from the ovarian endometrioma, whereas those arising from extragonadal lesions are rare. We report a rare case of endometrioid carcinoma that developed from deep infiltrating endometriosis in the uterosacral ligament 6 years after treatment for atypical proliferative endometrioid tumor of the ovary in a 48-year-old woman. Case presentation Six years ago, the patient underwent laparoscopic bilateral salpingo-oophorectomy for her right ovarian tumor with atypical proliferative (borderline) endometrioid tumor accompanied by ovarian endometrioma. The solid tumor in the cul-de-sac was detected during follow-up using magnetic resonance imaging. Positron emission tomography/computed tomography revealed an abnormal accumulation of 18F-fluorodeoxyglucose at the tumor site. Thus, tumor recurrence with borderline malignancy was suspected. The patient underwent diagnostic laparoscopy followed by hysterectomy and partial omentectomy. Retroperitoneal pelvic lymphadenectomy and para-aortic lymphadenectomy were also performed. The cul-de-sac tumor at the left uterosacral ligament was microscopically diagnosed as invasive endometrioid carcinoma arising from deep infiltrating endometriosis. The final diagnosis was primary stage IIB peritoneal carcinoma. The patient received six courses of monthly paclitaxel and carboplatin as adjuvant chemotherapy. The patient showed no evidence of recurrence for 2 years after the treatments. Conclusion This study reports a rare case of metachronous endometriosis-related malignancy that developed 6 years after treatment for borderline ovarian tumor. If endometriosis lesions remain after bilateral salpingo-oophorectomy, the physician should keep the malignant nature of endometriosis in mind.

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