Laparoscopic diagnosis and treatment of urinary tract endometriosis in a referral center

Laparoscopic diagnosis and treatment of urinary tract endometriosis in a referral center

Maria Manzone1, Matteo CeccarelloOrcid, Francesco Bruni1, Giovanni RoviglioneOrcid, Roberto ClariziaOrcid, Daniele MautoneOrcid, Giuseppe CaleffiOrcid Alberto MolinariOrcid Marcello Ceccaroni1 – Orcid

1 – Department for the Protection of Women’s Health and Quality of Life, ISSA International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Maria Manzone

maria.manzone@sacrocuore.it


DOI: 10.53146/lriog1202133

Abstract

The diagnosis of extra-genital Deep Endometriosis is very frequent in referral centers. The urinary tract represents the second most affected extra-genital site. Bladder Endometriosis is defined as Deep Endometriosis infiltrating the detrusor muscle, partially or fully. Ureteral endometriosis is subdivided into intrinsic and extrinsic form, with an obstruction to the spread of parametric Deep Endometriosis. Patients often come to a referral center after a long period of lack of medical therapy and / or several incomplete surgeries. While patients with Bladder Endometriosis are symptomatic, Ureteral Endometriosis is more often low / asymptomatic, leading to progressive and silent renal failure. Having a systematic model of pre-operative diagnosis, an intra-operative evaluation plan using the cooperation of a multi-disciplinary team in a referral center, represents the solution able to reducing the consequences of late diagnosis and offer precise surgical treatment. A complete ultrasound scan (pelvic and abdominal) performed by an experienced operator could allow the diagnosis; second level exams (Magnetic Resonance Imaging, CT urograhy, scintigraphy) can help to confirm and define it. The treatment of Bladder Endometriosis depends on various factors (symptoms, extent of the disease, age of the patients, childbearing desire). In cases of refractory to medical therapy, laparoscopic surgery is the treatment that leads to more complete cure, long-term relief of symptoms and low relapse rates. Any ureteral stenosis caused by an intrinsic lesion requires a ureteral resection. Ureterolysis is the procedure for removing extrinsic ureteral lesions that do not cause direct stenosis, preventing disease progression. An intraoperative evaluation of the ureters after ureterolysis is mandatory to determine the surgical outcome. The laparoscopic nerve-sparing eradication of Deep Endometriosis of the urinary tract is the way to provide good results in terms of symptoms’ control and relapses, an improvement of quality of life with a low post-operative complications rate. The possibility in a reference center to make use of a multidisciplinary team is essential to be the best surgical strategy before and intraoperatively.

Keywords: deep endometriosis; bladder endometriosis; ureteral endometriosis; partial cystectomy; uretero-neocystostomy.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Adnexal surgery “fertility sparing” in deep endometriosis

Adnexal surgery “fertility sparing” in deep endometriosis

Anna Katarzyna StepniewskaOrcid, Giulia Mantovani1, Chiara Signori1, Maria Manzone1, Silvia BaggioOrcid, Paola De MitriOrcid, Marcello CeccaroniOrcid

1 – Department for the Protection of Women’s Health and Quality of Life, ISSA International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Anna Katarzyna Stepniewska

stepniewska.anna@gmail.com


DOI: 10.53146/lriog1202132

Abstract

Adnexal surgery in deep endometriosis represents a significant clinical problem because the patients who suffer from it are typically of childbearing age and often, in addition to aiming for the improvement of painful sym- ptoms, have a desire for pregnancy. Endometriosis can cause infertility and the surgical removal of the disease implies a good chance of conception; at the same time surgery, in particular of endometriomas, involves the risk of a reduction in the ovarian reserve, up to its extreme consequence represented by premature menopause. For this reason, the indications for surgery must be evaluated very carefully and accompanied by an appropriate instrumental study that allows for an adequate surgical procedure; all this, in order to radically remove the disease and not expose the patient to a high risk of recurrence resulting in subsequent surgical gestures and a consequent further reduction of the ovarian reserve. Histological, anatomical aspects and hints on surgical instrumentation are presented, all useful for choosing the most appropriate surgical approach. The various traditional and innovative surgical techniques are also discussed and other additional procedures useful to reduce the risk of decreased ovarian reserve and postoperative adhesions are described.

Keywords: deep endometriosis; laparoscopic surgery; ovarian reserve; fertility.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Medical therapy for endometriosis: choice from puberty to menopause

Medical therapy for endometriosis: choice from puberty to menopause

Simone Ferrero1,2 Orcid, Giulio Evangelisti1,2 Orcid, Fabio Barra1,2 Orcid

1 – IRCCS San Martino Polyclinic Hospital, Genoa

2 – DINOGMI, University of Genoa

Corresponding Author: Simone Ferrero

simoneferrero@me.com


DOI: 10.53146/lriog1202131

Abstract

Medical therapies aim to improve endometriosis-related pain and to decrease the post-operative recurrence of endometriosis, but they have no role in improving surgery for endometriosis or infertility. Since medical treatments do not cause the disappearance of endometriosis, they should ideally be administered from the diagnosis up to the menopause. First-line therapies for the treatment of endometriosis are non-steroidal anti-inflammatory drugs, progestins and combined oral contraceptives. When these therapies fail to provide adequate pain relief, patients may be treated with gonadotropin- releasing hormone agonists, gonadotropin-releasing hormone antagonists, danazol and aromatase inhibitors. During treatment, patients must be monitored in order to evaluate symptoms and the potential progression of endometriosis by transvaginal ultrasonography.

Keywords: endometriosis; estrogen-progestins; progestogens; GnRH analogues; GnRH antagonists; aromatase inhibitors.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Lriog-2021-3

LRIOG N.3 2021

In questo numero:

Editorial

Endometriosis: a body and soul disease

PDF DOI:10.53146/lriog1202141 Abstract

Original articles

Epidemiology and social impact of endometriosis today

Silvia Baggio, Giulia Mantovani, Paola De Mitri, Matteo Ceccarello, Maria Manzone, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202128 Abstract

Ultrasound diagnostic criteria for ovarian and deep endometriosis

Mara Albanese, Carlotta Zorzi, Anna Katarzyna Stepniewska, Paola De Mitri, Giamberto Trivella, Silvia Baggio, Mariangela Fornalè, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202129 Abstract

The role of a reference center in the multidisclipinary and interdisciplinary treatment of pelvic endometriosis

Daniele Mautone, Simone Orlandi, Giuseppe Caleffi, Giuseppe Deledda, Giovanni Foti, Elena Rossato, Stefano Cavalleri, Giacomo Ruffo, Luca Garriboli, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202130 Abstract

Medical therapy for endometriosis: choice from puberty to menopause

Simone Ferrero, Giulio Evangelisti, Fabio Barra

PDF DOI:10.53146/lriog1202131 Abstract

Adnexal surgery “fertility sparing” in deep endometriosis

Anna Katarzyna Stepniewska, Giulia Mantovani, Chiara Signori, Maria Manzone, Silvia Baggio, Paola De Mitri, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202132 Abstract

Laparoscopic diagnosis and treatment of urinary tract endometriosis in a referral center

Maria Manzone, Matteo Ceccarello, Francesco Bruni, Giovanni Roviglione, Roberto Clarizia, Daniele Mautone, Giuseppe Caleffi, Alberto Molinari, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202133 Abstract

Laparoscopic diagnosis and treatment of intestinal endometriosis

Roberto Clarizia, Giovanni Roviglione, Francesco Bruni, Daniele Mautone, Carlo Tricolore, Matteo Ceccerello, Paola De Mitri, Giacomo Ruffo, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202134 Abstract

Diaphragmatic endometriosis: diagnosis and laparoscopic treatment

Giovanni Roviglione, Roberto Clarizia, Daniele Mautone, Francesco Bruni, Matteo Ceccarello, Alberto Claudio Terzi, Marcello Ceccaroni

PDF DOI:10.53146/lriog1202135 Abstract

Treatment of complication after colo-rectal surgery for endometriosis

Roberto Rossini, Elisa Bertocchi, Giacomo Ruffo

PDF DOI:10.53146/lriog1202136 Abstract

The management of urological complications in surgery for the treatment of severe endometriosis

Giuseppe Caleffi

PDF DOI:10.53146/lriog1202137 Abstract

Pelvic floor dysfunction: role of proctologist and rehabilitator

Simone Orlandi, Daniela Sorrentino

PDF DOI:10.53146/lriog1202138 Abstract

The role of pain relief in the management of chronic pelvic pain in deep endometriosis

Gilberto Pari, Gianfranco Sindaco, Marco La Grua, Valentina Paci, Matteo Zanella, Alberto Merlini,
Simone Vigneri

PDF DOI:10.53146/lriog1202139 Abstract

Critical Review

Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

Marcello Ceccaroni, Roberto Clarizia, Giovanni Roviglione, Francesco Bruni, Daniele Mautone, Giacomo Ruffo

PDF DOI:10.53146/lriog1202140 Abstract

Quarterly magazine: Nr.3 – 2021

e – ISSN: 1824 – 0283

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Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

Marcello CeccaroniOrcid, Roberto Clarizia1, Giovanni Roviglione1, Francesco Bruni1, Daniele MautoneOrcid, Giacomo RuffoOrcid

1 – Department of Obstetrics and Gynecology, Gynecological Oncology and Mini – Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

2 – Department of General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Marcello Ceccaroni

marcello.ceccaroni@sacrocuore.it


DOI: 10.53146/lriog1202140

Abstract

Nerve-Sparing (NS) surgery is a technique which, in the last decades, has shown to be highly effective in order to significantly reduce intestinal, vesical and sexual dysfunctions without reducing surgical results in eradicating Deep Infiltrating Endometriosis (DIE). Following a correct and standardized anatomo-surgical approach, NS technique for DIE can be reproducible by the pelvic surgeon who desires to face surgery for DIE and can lead, for what is possible in severe cases, to an optimal preservation of the majority of the visceral nerve fibers of the pelvis. This approach has shown not to have a negative impact over recurrence rates, which are similar to those related to the classical technique, such as the rates of efficacy over chronic pelvic pain.

Keywords: deep infiltrating endometriosis; laparoscopy; nerve-sparing; radical surgery; surgical anatomy.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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The role of a reference center in the multidisclipinary and interdisciplinary treatment of pelvic endometriosis

The role of a reference center in the multidisclipinary and interdisciplinary treatment of pelvic endometriosis 

Daniele MautoneOrcid, Simone OrlandiOrcid, Giuseppe CaleffiOrcid, Giuseppe DeleddaOrcid, Giovanni Foti1Orcid, Elena Rossato1Orcid, Stefano Cavalleri1, Giacomo RuffoOrcid, Luca GarriboliOrcid Marcello Ceccaroni1– Orcid

1 – IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona

Corresponding Author: Daniele Mautone

daniele.mautone@sacrocuore.it


DOI: 10.53146/lriog1202130

Abstract

Endometriosis is a chronic hormone-dependent disease affecting approximately 25-30% of women in the third and fourth decade. Despite its frequency, it is often detected late. The aim of this article was to present a standardized treatment algorithm for an interdisciplinary endometriosis consultation considering medical and surgical approaches. Despite the frequency of endometriosis and a high number of publications dealing with the disease there is a lack of evidence in literature for standardized treatment algorithms allowing a rational diagnostic, medical, multiprofessional and therapeutic approach. The diagnosis includes a structured medical history with the identification of endometriosis-typical symptoms and a gynecological rectovaginal examina- tion, if necessary additional examinations. The treatment algorithm is essentially divided into the phase of diagnosis and the phase of therapy as well as the prevention of recurrence or long-term treatment. A multi-professional team of gynaecology, visceral surgery, vascular surgery ,urology, nutritional medicine, physiatry, gastroenterology, physiotherapy, psychology and psychiatry can be consulted for support. The treatment of endometriosis should be multiprofessional, standardized and reproducible during specialized consultations at certified centers.

Keywords: endometriosis; referral center; endometriosis unit; interdisciplinary approach.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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