New Paradigms in Endometriosis Surgery of the Distal Ureter

It is estimated that 2% of endometriosis cases involve the urinary tract and that the ureter is involved in up to 30% of these cases, or 0.6% of all endometriosis cases. Increasingly, the standardization and systematization of surgical treatment of endometriosis require the surgeon to have knowledge of the surgical spaces and the ureteral and surrounding pelvic anatomy in order to carry out a cytoreductive surgery that is as possible. A thorough workup is essential for the differentiation of intrinsic or extrinsic endometriosis of the ureter. The use of the resonance imaging preoperatively and ureteroscopy intraoperatively is now considered indispensable. The decision and choice of the best technique will be guided by the diagnosis (intrinsic or extrinsic), the location of the lesions, the length of the involved segment (greater or less than 3 cm), vitality of the ureter stumps, and anastomosis without tension. The main alternatives are ureterolysis and dilatation with balloon catheter which is performed for extrinsic endometriosis more than 85% of the time and ureterectomy for intrinsic endometriosis. To perform the reconstruction, the techniques with end-to-end anastomosis with the distal ureter stump or uretero-vesical reimplantation are used. Increasingly, with better knowledge of the distal ureter anatomy, easier access through laparoscopy and in contradiction to the current recommendations, we are verifying that the end-to-end anastomosis has become the preferred option or procedure of choice for ureteral reconstruction, with ureterovesical reimplantation the second option

Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions.

Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3-31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55-94.9) and 65% (95% CI: 45-85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments

Five-Month Follow-Up Assessing Defecography and Urodynamics after Laparoscopic Nerve-Sparing Colorectal Resection for Endometriosis

Introduction. Large resections may be necessary in cytoreductive surgery for endometriosis, which present risk of urinary and bowel complications. Presentation of Case. A 29-year-old woman underwent multidisciplinary laparoscopy for endometriosis in a private practice setting for acyclic pelvic pain and cyclic abdominal distension with changes in bowel habits and frequent sensation of incomplete defecation. After surgery, urodynamics remained normal and bowel function improved subjectively and objectively per dynamic magnetic resonance defecography (DMRD). The five-month follow-up found improvements in pain scores, bowel function, and health-related quality of life (assessed by the full versions of the Short Form 36 and Endometriosis Health Profile 30 scales). Discussion. Animus may contribute to the bowel symptoms in women with endometriosis. DMRD provides additional objective parameters for comparing pre- and postoperative functions. Conclusion. A nerve-sparing segmental rectosigmoidectomy for endometriosis carefully executed by a multidisciplinary team can preserve the function of different pelvic organs

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study

Conflito de interesse: nenhum potencial conflito de interesse relevante para este artigo foi relatado.Submitted by Maria Arruda ([email protected]) on 2020-02-10T15:44:44Z No. of bitstreams: 1 Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life - a sectional observational study.pdf: 599379 bytes, checksum: a1c7addf1d5b5179879e9bf1dcc32864 (MD5)Approved for entry into archive by Maria Arruda ([email protected]) on 2020-03-24T20:32:40Z (GMT) No. of bitstreams: 1 Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life - a sectional observational study.pdf: 599379 bytes, checksum: a1c7addf1d5b5179879e9bf1dcc32864 (MD5)Made available in DSpace on 2020-03-24T20:32:40Z (GMT). No. of bitstreams: 1 Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life - a sectional observational study.pdf: 599379 bytes, checksum: a1c7addf1d5b5179879e9bf1dcc32864 (MD5) Previous issue date: 2018-09Este estudo foi apoiado pelos Programas do Governo Federal Brasileiro PIBIC / PIBITI / PIP da Fundação Oswaldo Cruz (Fiocruz) do Ministério da Saúde e Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) do Ministério da Ciência e Tecnologia ( PIP IFF-008-FIO-13-3-4). Os autores agradecem a Roberta Pacheco da Luz Fonseca (enfermeira e paciente) e ao Dr. Claudio Moura Andrade Jr. (cirurgião experiente no campo da endometriose) por contribuírem para a discussão e revisão do manuscrito.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Instituto Crispi de Cirurgias Minimamente Invasivas. Rio de Janeiro, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Hospital Federal da Lagoa. Departamento de Urologia. Rio de Janeiro, Brasil.Instituto Crispi de Cirurgias Minimamente Invasivas. Rio de Janeiro, Brasil.OBJETIVO: Avaliar a correlação entre diferentes sintomas de dor e diferentes domínios da qualidade de vida relacionada à saúde da mulher (QVRS). MÉTODOS: Setenta e sete mulheres com endometriose infiltrativa profunda foram sucessivamente inscritas entre junho de 2011 e agosto de 2013, enquanto estavam preparadas para realizar laparoscopia devido a dor e / ou infertilidade. Quantificamos as intensidades de dismenorreia, dispareunia profunda, dor pélvica crônica e disquezia (menstrual e não menstrual) usando uma escala visual analógica de 11 pontos (EVA: 0-10) e as versões completas validadas do Short Form 36 (SF36 ) e questionários de Perfil de Saúde em Endometriose (EHP30) para avaliar a QVRS. Os sintomas da dor foram considerados simultaneamente em um método de agrupamento hierárquico aglomerado (abordagem exploratória multivariada) e as associações entre os escores foram testadas por correlação bivariada. RESULTADOS: A dismenorreia mostrou a menor semelhança com a análise multivariada de agrupamentos e sem correlação estatisticamente significante com os outros sintomas de dor: dispareunia profunda (P = 0,244), dor pélvica crônica (P = 0,108), disquezia menstrual (P = 0,238) e não- disquezia menstrual (P = 0,380). Dismenorreia e dor pélvica crônica foram os principais sintomas correlacionados com todos os domínios dos questionários SF36 e EHP30 (instrumento principal) (P <0,05). CONCLUSÃO: Dismenorreia e dor pélvica crônica foram fatores independentes associados à QVRS.OBJECTIVE: To assess the correlation between different pain symptoms and different domains of women's health-related quality of life (HRQoL). METHODS: Seventy-seven women with deep infiltrating endometriosis were successively enrolled between June 2011 and August 2013 while being prepared to undergo laparoscopy due to pain and/or infertility. We quantified the intensities of dysmenorrhea, deep dyspareunia, chronic pelvic pain, and dyschezia (menstrual and non-menstrual) using a 11-point visual analog scale (VAS: 0-10) and the validated full versions of the Short Form 36 (SF36) and Endometriosis Health Profile (EHP30) questionnaires to assess HRQoL. The pain symptoms were considered simultaneously in a hierarchical agglomerative clustering method (exploratory multivariate approach) and the associations among scores were tested by bivariate correlation. RESULTS: Dysmenorrhea showed the lowest similarity on to the multivariate cluster analysis and no statistically significant correlation with the other pain symptoms: deep dyspareunia (P=0.244), chronic pelvic pain (P=0.108), menstrual dyschezia (P=0.238), and non-menstrual dyschezia (P=0.380). Dysmenorrhea and chronic pelvic pain were the main symptoms correlated with all domains of the SF36 and the EHP30 (core instrument) questionnaires (P<0.05). CONCLUSION: Dysmenorrhea and chronic pelvic pain were independent factors associated with HRQoL

Can reducing the number of stitches compromise the outcome of laparoscopic Burch surgery in the treatment of stress urinary incontinence? Systematic review and meta-analysis

ABSTRACT The retropubic colposuspension in the treatment of stress urinary incontinence has been rescued with the laparoscopic route. Some authors have reduced the number of stitches, from two to one, due to the difficulty of suturing by this route. To what extent can this modification compromise outcome? To answer this question, we performed a systematic review and meta-analysis on the MEDLINE/PubMed and LILACS/SciELO databases between 1990 and 2015. We included randomized clinical trials, cohort studies and case-control series comparing laparoscopic versus open Burch, and two versus one stitch in laparoscopic Burch, with a minimum follow-up of one year. Fourteen studies compared laparoscopic versus open Burch, in which we found no differences between the two techniques using one stitch (Relative Risk - RR - of 0.94, 95% CI 0.79-1.11) and two stitches (RR of 1.03, 95% CI 0.97-1.10). Only one study compared one stitch versus two stitches in laparoscopic Burch, with cure rates of 68% versus 87%, respectively (p-value= 0.02). We did not identify differences when compared open technique with two stitches versus laparoscopic with one stitch and open technique with two stitches versus laparoscopic with two. The study comparing one versus two laparoscopic stitches demonstrated superior results with the latter. Although there is no robust evidence, when Burch surgery is performed laparoscopically, the use of two stitches seems to be the best option