A New Perspective on the Problem of Concomitant Endometriosis and Genital Malformations: Surgical and Embryogenetic Aspects

Study Objective To optimize the results of surgical treatment and rehabilitation of patients with genital tract malformations combined with external genital endometriosis. Design Prospective study. Level II. Setting Department of Operative Gynecology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation. Patients or Participants 453 patients with utero-vaginal malformations underwent surgery from 2013 to 2018. Based on the presence of endometriotic foci, two groups of patients were created: group 1 included 240 patients with uterine and vaginal malformations and external genital endometriosis; group 2 included 213 patients with uterine and vaginal malformations without concomitant endometriosis. Interventions All patients underwent surgical treatments using laparocopic and hysteroscopic approaches for correction of congenital malformations and endometriosis excision. Measurements and Main Results The indications for surgical treatment of patients with utero-vaginal anomalies included primary infertility in 41.5%, secondary infertility in 18.6%, recurrent miscarriages in 26.2%, dysmenorrhea in 45.4%, menorrhagia in 23.2%, pain syndrome in 17.2%, and dyspareunia in 8.1% cases. External genital endometriosis was diagnosed in 53.0% of these patients. We revealed no significant difference in the incidence of endometriosis in patients with utero-vaginal anomalies with or without the obstruction to the menstrual flow. Conclusion Implantation theory cannot explain the development of endometriosis in all patients with utero-vaginal malformations. Therefore, all pathogenetic theories must be considered in the investigation of possible mechanisms of endometriosis development in patients with genital tract malformations.