OC22.01: Transvaginal sonography‐based minimal invasive surgery for urinary tract endometriosis: test accuracy and outcomes

Abstract

Objectives:To evaluate the accuracy of TVS for preoperative detection of bladder endometriosis (BE) and to describe TVS-based surgical outcomes of women undergoing laparoscopic procedures for UTE including BE and/ or hydronephrosis (HN). Methods: Retrospective cohort study of patients with suspected deep infiltrating endometriosis (DIE) as demonstrated by TVS underwent radical laparoscopic resection, which consisted of laparoscopic partial cystectomy (PC), ureterolysis (UL), ureteric end-to-end anastomosis (UEEA) or ureteroneocystostomy (UNC) at our department. Results: Out of 207 patients with DIE, 43 exhibited UTE consisting of 25 patients with BE and 20 women with solitary or additional HN. Sensitivity, specificity, positive and negative predictive values and likelihood ratios for TVS regarding BE were 96%, 99%, 96%, 99%; 174,7 (24.7-1235.7 95% CI) and 0.04 (0.01-0.27 95% CI). All women with BE underwent PC. In cases of HN, 14 conservative ULs, 3 UEEAs and 3 UCNs were performed. Thirteen women with concomitant DIE of the rectum also underwent bowel resection. Laparoscopic surgery was feasible in 41/43 (conversion rate 5%) women with UTE. Median duration of surgery was 200 minutes, median blood loss 1.6 g/d with a median hospital stay of 8.6 days. We observed 3 complications according to Clavien-Dindo III including 1 leak following UEEA, 1 re-stenosis after UL and 1 subcutaneous hematoma. After a median follow-up of 29.5 months, we observed a significant decrease in dysmenorhhea (7.7 to 1.3; p=0.001), dyspareunia (3.8 to 1.1, p=0.001), dysuria (3.3 to 1.1; p=0.001) and increase in QoL (3.1 to 8.3; p=0.001). In subfertile women (23/43, 54%), the overall clinical pregnancy rate and life birth rate was 44% and 33%. Conclusions: TVS is highly accurate for presurgical diagnosis of BE. Laparoscopic surgery for BE and UTE including HN is safe, feasible and efficient regarding reduction of pain symptoms and treatment of subfertility with a low rate of complications. OC22.02Diagnostic accuracy of the transvaginal ultrasound ''sliding sign'', direct visualisation and combination of both for the prediction of deep infiltrating endometriosis of the rectum and the rectosigmoid M. Espada 6 , C. Objectives: 1. To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) direct visualisation (DV) of rectal/rectosigmoid (RS) nodules compared to the "sliding sign" (SS) to predict deep infiltrating endometriosis (DIE) of the rectum ® and the RS during laparoscopy.2.To evaluate the diagnostic accuracy of the combination of both techniques (DV+SS) to predict DIE of the R or the RS. Methods: Multicentre prospective observational study from January 2009 to February 2017,including patients with suspected endometriosis. All women underwent TVS to evaluate the ''sliding sign'' or if a nodule within the rectal/rectosigmoid wall was visualised, followed by laparoscopic surgery. The association between the SS and the DV during the TVS were correlated to the presence of rectal/rectosigmoid DIE at laparoscopy. Fisher's exact test wa...