endometriosis

Endometriosis



Endometriosis is the presence of endometrium (glandular stromal cells) in the wrong places (e.g. peritoneal cavity, a href=/tags/Cervix/1180/, vulva). This includes menstruating women (7-15% of the population) and occurs infrequently in the postmenopausal period and before puberty. Pathogenesis of this disease is still not completely known - scientists have found a few theories until now (which are not mutually eliminated). The theory of spreading suggests that the focus of endometrial tissues are directly distributed to places affected by disease by gynecological, surgery and medical operations and interventions. Another theory assumes that in the peritoneal cavity is a stake of poorly differentiated cells that are subjected to metaplasia to the endometrium after simulation by undetermined impulse. Regurgitation theory has also lots of followers - the menstrual blood, in some cases, can go back through the fallopian tubes into the peritoneal cavity, and in case of low efficiency of the immune system (endometrial cells are not removed) follows implantation and development of pathological lesions. Hyperestrogenism often occurs in women with endometriosis. Scientific reports and disposition also suggest the role of genetic factors in the pathogenesis of the disease. The gold standard in the diagnosis of endometriosis is <a href=/tags/laparoscopy/26laparoscopy (often with <a href=” /tags/BIOPSY/1749”>biopsy</a>). CT and MR is sometimes helpful as well. CA-125 is a nonspecific marker of this pathology.


Classification


The classic topographical division (by Martius) distinguishes three types of disease depending on the location: endometriosis genitalis interna (uterus, fallopian tube), endometriosis genitalis externa (other parts of the reproductive system), endometriosis extragenitalis (outside of the reproductive system – eg. in the peritoneal cavity). Is also designed histological classification (scale Brosens): mucosal type (found in ovarian endometrial cysts), peritoneal type (multifocal and morphological variety) and the glandular type (the main element is a fibro-muscular tissue and affects profoundly infiltrating endometriosis). Division because of the advancement of the changes is not developed until now.


Symptoms


Endometriosis may be asymptomatic or can present wide range of symptoms. The most common symptoms include: painful periods, painful voiding and sexual relations, menstrual disorders (abundant or scant, irregular bleeding), the incidence of acute abdomen-like symptoms, PMS and the presence of blood faeces and urine. It is worth remembering that endometriosis is one of the common causes of infertility.


Treatment


The treatment regimens of endometriosis are based on a combination of pharmacotherapy and surgery. The aim of the therapy is to eliminate disease lesions, relieve the pain and restoration of fertility. Drugs used in therapy are: GnRH analogues (inhibitors of gonadotropins secretion), contraceptive pills (relieve pain) and progestogens (causing absence of menstruation, ovulation and endometrial atrophy). Depending on the location, extent, stage, age and prognosis were selected appropriate methods of treatment - coagulation, vaporization, and simple excision of the changes.

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Frozen Pelvic Endometriosis Gr-4-Chocolat Cyst

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Surgical video case: frozen pelvic endometriosis gr-4-chocolat cyst. Dr Ami shah - Assistant doctor-sumiran IVF center. Dr Sonu Malviya-Assistant doctor, Sumiran IVF center. Dr Aayesha Farooqui - Assistant...

Non-oncologic Use of Peritonectomy for the Treatment...

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Step by step for en bloc removal of endometriosis by peritonectomy of the posterior compartment of the pelvis. Considering endometriosis a Mullerian defect, it needs to be removed respecting the path...

Endometriosis with Versius Robotic Platform -...

Marcelo Avella

Specialty:  Gynecology
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In this video case we can see the use of Versius robot in a patient with deep endometriosis, where circular stapling was performed in the intestinal lesion.

Left Endometrioma Excision

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Surgical video case: laparoscopic excision of left endometrioma. 

Deep Endometriosis Posterior Compartment en Bloc...

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Surgical video case: bilateral parametrial endometriosis, complete posterior compartiment dissection and excision.

Endometrial Polyp and Submucous Fibroid

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Surgical video case: hysteroscopy of endometrial polyp and submucous fibroid.

Obturator Nerve Endometriosis Treat by Peritonectomy...

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Video case description: endometriosis on left obturator nerve with left leg pain on menses, treated by complete peritonectomy of posterior compartment of pelvis. 

Ureteric Dissection

Tarek Saleh

Specialty:  Gynecology
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Video case: stage 4 endometriosis with recto vaginal nodule pulling the right ureter.

Discoid Resection with Histerectomy for Deep...

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Surgical video case: discoid bowel resection with histerectomy performed by dr Igor Chiminacio, Paraná, Brasil. We are a reference center in treatment of endometriosis.

Okabayashi Space Dissection for Endometriosis...

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Okabayashi space: a safe way to preserve hypogastric nerve.