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

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

Giuseppe Caleffi

DSS in Urological Surgery Minimally invasive laparoscopy Operative Unit of Urology – IRCCS “Sacro Cuore-Don Calabria” – Negrar (VR); ISSA teacher (International School of Surgical Anatomy)

giuseppe.caleffi@sacrocuore.it


DOI: 10.53146/lriog1202137

Abstract

The iatrogenic damage to the urinary tract during gynecological surgery for the eradication of pelvic endometriosis can have significant morbidity. Although most cases of ureteral injury can occur even in the absence of significant risk factors, the incidence of urinary tract injury increases especially in patients with visceral adhesions secondary to previous pelvic surgery or inflammatory bowel disease, infections and patients with deeply infiltrating pelvic endometriosis (DIE), which can lead to a structural distortion of normal surgical plans. The most commonly affected sites are the ureter and the bladder. Early identification of such injuries is essential to minimize the impact of the damage on the patient; in fact, their identification in the intraoperative phase could not even determine outcomes both from a psychological and an organic-functional point of view for the patient. We will then discuss some anatomical considerations for their prevention, the diagnostic techniques for identification and characterization, as well as the reconstructive surgical techniques and the principles of repair.

Keywords: iatrogenic injury; repair, ureter; bladder; endometriosis.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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