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

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

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

Interdisciplinary Operative Unit of Pain Medicine and Therapy. Regional Reference Center – Accredited Hospital of Santa Maria Maddalena, Rovigo

Advanced Algology Research – Recognized association for scientific research, Rimini

Corresponding Author: Gilberto Pari

g.pari@medicinadeldolore.org


DOI: 10.53146/lriog1202139

Abstract

In some patients endometriosis causes persistent or chronic pain, becoming a specialistic algologic problem. Considering various possible pathogenic pain mechanisms, when pain therapy of endometriosis cannot be etiologic, far from being only symptomatic, it is based on a pathogenetic criterion. We must consider that in endometriosis pain can be due to activation of nociceptors sensibilized by endometriosic tissues (tissutal nociceptive pain), unresponding to NSAIDs and opioids, or to the nerve damage by nerve compression from endometriosic cistis or by involvement of nerve structures in scar tissue (neuropathic pain), unresponding to antinociceptive therapy but responding, at least partially, to some neuropathic specific pain drugs and to electrostimulation of the nervous system. And finally, we can have nociplastic pain, where cerebral and spinal neuroplasticity is the main mechanism causing pain: when facing this type of pain, the only effective management should follow a biopsychosocial and interdisciplinary model.

Keywords: endometriosis; chronic pelvic pain; pain therapy; interdisciplinary management.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Pelvic floor dysfunction: role of proctologist and rehabilitator

Pelvic floor dysfunction: role of proctologist and rehabilitator

Simone OrlandiOrcid, Daniela Sorrentino2

1 – Proctologist Surgeon and Medical Director at the Digestive Endoscopy Department of the Sacro Cuore Don Calabria Hospital, Negrar (VR)

2 – Pelvic floor therapist at Sacro Cuore Diagnostic Therapeutic Center, Verona

Corresponding Author: Simone Orlandi. Daniela Sorrentino

simone.orlandi@sacrocuore.it, daniela.sorrentino@sacrocuore.it


DOI: 10.53146/lriog1202138

Abstract

The importance of pelvic floor evaluation and rehabilitation is now recognized in the scientific world. In particular, pelvic pain, proctological and sexual dysfunctions are often present in women with endometriosis, strongly affecting their quality of life. Knowing the symptoms, related disorders and sharing the patients taken in care among the specialists, allows to better clarify the clinical picture, improve the therapeutic path and help to give a new self vision.

Keywords: pelvic floor dysfunctions; endometriosis; pelvic floor overactive; chronic pelvic pain.


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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Treatment of complication after colo-rectal surgery for endometriosis

Treatment of complication after colo-rectal surgery for endometriosis

Roberto RossiniOrcid, Elisa BertocchiOrcid, Giacomo RuffoOrcid

1 – U.O.C. General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Roberto Rossini

roberto.rossini@sacrocuore.it


DOI: 10.53146/lriog1202136

Abstract

Background: endometriosis is a chronic benign disease, characterized by the presence of endometrial glands and stroma outside the uterine cavity. It can frequently affect the intestinal tract, the rectum and the sigmoid colon are often interested. Surgery is a valid option in case of infertility, chronic pelvic pain, intestinal obstruction and worsening of quality of life. Postoperative outcome is often favourable. Most frequent complication are colorectal and recto-vaginal fistulas. Aim of our study is to review our datas and present our experience in the treatment of colo-rectal complication after surgery for endometriosis
Methods: we retrospectively included 3054 cases of colorectal surgery for intestinal endometriosis performed from 2001 to 2020 in our institution. On the basis of the postoperative outcome we included 543 complications for the segmental resection and 50 for the disc resection.
Results: major colo-rectal complications such as anastomotic leackage and recto-vaginal fistula were 218 (8.3%) and 43 (1,6 %) respectively. Other intestinal complications were: 23 (0.9%) bowel occlusions, 15 (0.3%) intestinal perforations and 132 (5.0%) anastomotic strictures. We also had 76 (2.9%) haemoperitoneum and 36 (1.4%) urinary tract injuries. The group of disc resection only had 47 (11.3%) intraluminal bowel bleeding and 3 (0.7%) perforations.
Conclusion: when conservative treatment fails surgery represents a safe and feasible approach for bowel deep infiltrating endometriosis, resulting in an improvement of pain, fertility and quality of life. The rate of complications after bowel resection appear to be acceptable and often reversible. To achieve this goal surgeons, gynecologist, urologist and all other professionals of the multidisciplinary team from high volume centers need to work together.

Keywords: endometriosis; colorectal resection; complications; anastomotic leackage; recto-vaginal fistula.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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