Diagnosi e trattamento laparoscopico dell’endometriosi del tratto urinario in un centro di riferimento

Diagnosi e trattamento laparoscopico dell’endometriosi del tratto urinario in un centro di riferimento

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

1 – Dipartimento per la Tutela della Salute e della Qualità di Vita della Donna, ISSA International School of Surgical Anatomy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Chirurgia Annessiale “fertility sparing” nell’endometriosi profonda

Chirurgia Annessiale “fertility sparing” nell’endometriosi profonda

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

1 – Dipartimento per la Tutela della Salute e della Qualità di Vita della Donna, ISSA International School of Surgical Anatomy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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La scelta della terapia medica in endometriosi dalla pubertà alla menopausa

La scelta della terapia medica in endometriosi dalla pubertà alla menopausa

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

1 – IRCCS Ospedale Policlinico San Martino, Genova

2 – DINOGMI, Università degli Studi di Genova

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Il ruolo di un centro di riferimento nel trattamento multidisciplinare ed interdisciplinare dell’endometriosi pelvica

Il ruolo di un centro di riferimento nel trattamento multidisciplinare ed interdisciplinare dell’endometriosi pelvica  

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

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Il ruolo della terapia antalgica nella gestione del dolore pelvico cronico in endometriosi profonda

Il ruolo della terapia antalgica nella gestione del dolore pelvico cronico in endometriosi profonda

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

U.O. interdisciplinare di Medicina e Terapia del Dolore. Centro di Riferimento Regionale
– Ospedale Accreditato Santa Maria Maddalena, Rovigo

Advanced Algology Research -Associazione riconosciuta per la ricerca scientifica, Rimini

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Le disfunzioni del pavimento pelvico: ruolo del proctologo e del riabilitatore

Le disfunzioni del pavimento pelvico: ruolo del proctologo e del riabilitatore

Simone OrlandiOrcid, Daniela Sorrentino2

1 – Chirurgo Proctologo e Dirigente Medico presso il reparto di Endoscopia Digestiva dell’Ospedale Sacro Cuore Don Calabria, Negrar (VR)

2 – Terapista del pavimento pelvico presso Centro Diagnostico Terapeutico Sacro Cuore, Verona

Autori di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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