Laparoscopic Uterine Artery Ligation for Treatment of Symptomatic Adenomyosis
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Adenomyosis
Internal iliac artery
Cuff
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Chronic pelvic pain and endometriosis remain two of the most perplexing problems in gynecology. In some women with both conditions, endometriosis might not be the cause of their pain. The problem is determining when the pain is caused by endometriosis. On the basis of clinical studies, I suggest three criteria that should be met before attributing chronic pelvic pain to endometriosis. First, the pelvic pain should be cyclic because endometriosis is a hormonally responsive disease. Second, endometriosis should be diagnosed surgically to avoid overdiagnosing this condition. Finally, medical or surgical treatment of endometriosis should result in prolonged pain relief. Application of these evidence-based criteria reminds us that endometriosis often can be asymptomatic, even in some women with chronic pelvic pain. These criteria might help gynecologists determine the women for whom surgical therapy will resolve the pain; however, only prospective evaluation can determine their ultimate usefulness.
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[Objective] To determine the expression of angiopoietin-2 (Ang-2) in eutopic and ectopic endometrium of endometriosis and adenomyosis, and to investigate the role of it in the pathogenesis of endometriosis and adenomyosis. [Methods] Expression of Ang-2 mRNA in the eutopic and ectopic endometrium of 65 patients with endometriosis (endometriosis group) and 40 patients with adenomyosis (adenomyosis group) and the expression of Ang-2 mRNA in the normal endometrium of 30 patients (control group) without endometriosis and adenomyosis were detected by RT-PCR. [Results] Expression levels of Ang-2 mRNA in the eutopic and ectopic endometrium with endometriosis and adenomyosis were significantly higher than that in control group, and there was not significant relevance between the expression level and the clinical staging. [Conclusion] Expression of Ang-2 mRNA has a high level in the eutopic and ectopic endometriotic tissues with endometriosis and adenomyosis. Ang-2 may play a very important role in the development of endometriosis and adenomyosis and may relate to the pathogenesis of endometriosis and adenomyosis.
Adenomyosis
Pathogenesis
Clinical Significance
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In Brief Chronic pelvic pain and endometriosis remain two of the most perplexing problems in gynecology. In some women with both conditions, endometriosis might not be the cause of their pain. The problem is determining when the pain is caused by endometriosis. On the basis of clinical studies, I suggest three criteria that should be met before attributing chronic pelvic pain to endometriosis. First, the pelvic pain should be cyclic because endometriosis is a hormonally responsive disease. Second, endometriosis should be diagnosed surgically to avoid overdiagnosing this condition. Finally, medical or surgical treatment of endometriosis should result in prolonged pain relief. Application of these evidence-based criteria reminds us that endometriosis often can be asymptomatic, even in some women with chronic pelvic pain. These criteria might help gynecologists determine the women for whom surgical therapy will resolve the pain; however, only prospective evaluation can determine their ultimate usefulness. Before attributing chronic pelvic pain to endometriosis, there should be a surgical diagnosis, and the pain should be cyclic and relieved by specific treatment.
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Adenomyosis and fibroids are two uterine pathologies that have long been clinically associated with chronic pain in reproductive-aged women. However, data confirming a cause and effect relationship are sparse. Adenomyosis is a poorly defined and poorly investigated disorder. It is difficult to diagnose, and in most cases is not clearly pathologic; where the line is drawn between physiologic findings and a pathologic disorder is unknown. The scientific validity for specifically treating adenomyosis in the presence of pelvic pain is minimal. Uterine fibroids are common gynecologic findings but are unlikely to represent a source of chronic pelvic pain. Pressure symptoms and other repercussions from an enlarged uterus are more likely to be seen, and occasionally dyspareunia may be reported. Numerous treatments are available, but data regarding the successful treatment of chronic pelvic pain are nonexistent.
Adenomyosis
Uterine Fibroids
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Adenomyosis
Etiology
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Pelvic endometriosis
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In Brief OBJECTIVE: To estimate the prevalence of surgically confirmed endometriosis in women undergoing laparoscopic or abdominal hysterectomy, including those with and without preoperative indications of chronic pelvic pain or endometriosis, and to describe characteristics and operative findings associated with surgically confirmed endometriosis in women undergoing hysterectomy for chronic pelvic pain. METHODS: A retrospective cohort study was performed with 9,622 women who underwent laparoscopic or abdominal hysterectomy for benign indications in the Michigan Surgical Quality Collaborative from January 1, 2013, to July 2, 2014. The prevalence of surgically confirmed endometriosis, determined by review of the operative report and surgical pathology, was calculated for the entire cohort and for subgroups of women with and without chronic pelvic pain or endometriosis. Multivariate logistic regression models were used to identify characteristics associated with surgically confirmed endometriosis at the time of hysterectomy among women with chronic pelvic pain. RESULTS: Of the 9,622 hysterectomies available for analysis during the study period, 15.2% (n=1,465) had endometriosis at the time of hysterectomy. Among the 3,768 women with a preoperative indication of chronic pelvic pain, fewer than one in four had endometriosis (806/3,768 [21.4%]). Even among those with preoperative indication of endometriosis, many women did not actually have endometriosis at the time of hysterectomy (527/1,232 [42.8%]). The rate of unexpected endometriosis in women without a preoperative indication of chronic pelvic pain or endometriosis was 8.0% (434/5,457). Among women with a preoperative indication of chronic pelvic pain (n=3,786), multivariate analysis showed endometriosis was more common in women of younger age, white race, lower body mass index, and those who failed another treatment previously. Among those with pelvic pain, oophorectomy was more commonly performed in women with surgically confirmed endometriosis than those without (47.4% compared with 33.3%, P<.001). CONCLUSION: Fewer than 25% of women undergoing laparoscopic or abdominal hysterectomy for chronic pelvic pain have endometriosis at the time of surgery. Endometriosis is found in fewer than one fourth of women undergoing laparoscopic or abdominal hysterectomy for chronic pelvic pain.
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