Sliding sign and gel sonovaginography: A sneak peek prior to laparoscopy in patients with endometriosis

V, Spoorthy.; Anjali, M; Vasudeva, Akhila; Kumar, Pratap

doi:10.4103/jhrs.jhrs_169_19

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…64 In the perioperative period, a transvaginal ultrasound has been shown to be useful in identifying soft markers of pathology which can help medical professionals determine whether laparoscopic surgery will be of benefit. 65 Finally, prior to surgery, patients should be thoroughly counselled on their expectations of the surgery. As 1/3 to 1/2of diagnostic laparoscopies yield negative results, the associated psychological devastation felt by patients may significantly impact their engagement with the medical process which is associated with poor pain outcomes.…”

Section: Discussionmentioning

confidence: 99%

Chronic pelvic pain: An underrecognised perioperative consideration

Lam,

Zhang,

Oxenham

et al. 2023

Journal of Endometriosis and Pelvic Pain Disorders

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Chronic pelvic pain (CPP) is a prevalent disorder amongst women. The physiology of CPP is attributed to various neurophysiological mechanisms and endometriosis, adenomyosis, chronic infection and functional disorders such as irritable bowel syndrome or interstitial cystitis are all diseases which fall under the umbrella term of CPP. CPP and its associated multitude of causes can affect perioperative care through several mechanisms. Patients with CPP may be more likely to experience significant pain in the perioperative setting and preoperative pain can be a predictor of post-operative pain. Thus, optimisation of CPP prior to the perioperative period is an important consideration. Currently limited and conflicting evidence exists regarding the peri-operative pharmacological analgesia. The various aetiologies of CPP and patient medical history result in the inability to generalise one analgesic regime. Areas of further research includes neuromodulation techniques, genomic and proteomic biomarker studies and the applicability of artificial intelligence.

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Section: Discussionmentioning

confidence: 99%

Chronic pelvic pain: An underrecognised perioperative consideration

Lam,

Zhang,

Oxenham

et al. 2023

Journal of Endometriosis and Pelvic Pain Disorders

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“… 27 Previous studies evaluated the use of SVG for diagnosing DE. 15 , 17 , 18 , 31 , 32 , 33 , 34 A large Italian prospective study including 102 women, investigated SVG with saline solution compared with TVS and MRI to diagnose posterior DE. 18 The SE of SVG and MRI, respectively, was 97.1% and 94.3% for endometriotic involvement of vaginal fornix, 95.6% and 95.6% for uterosacral ligaments, and 100% and 77.8% for the rectovaginal septum.…”

Section: Discussionmentioning

confidence: 99%

A prospective study comparing rectal water contrast‐transvaginal ultrasonography with sonovaginography for the diagnosis of deep posterior endometriosis

Barra

Maggiore

Evangelisti

et al. 2021

Acta Obstet Gynecol Scand

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Introduction: Preoperative assessment of deep endometriotic (DE) nodules is necessary to inform patients about the possible treatments and provide informed consent in case of surgery. This study aims to investigate the diagnostic performance of rectal water-contrast transvaginal ultrasonography (RWC-TVS) and sonovaginography (SVG) in women with suspicion of posterior DE. Material and methods: This prospective comparative study (NCT04296760) enrolled women with clinical suspicion of DE at our institution (Piazza della Vittoria 14 SRL, Genoa, Italy). Exclusion criteria were the previous diagnosis of DE by imaging techniques or laparoscopy. All patients underwent RWC-TVS and SVG, independently performed by two gynecologic sonologists blinded to the other technique's results. Patients underwent laparoscopic surgery within the following three months; imaging findings were compared with surgical and histological results. Results: In 208 out of 281 (74.0%) patients included, posterior DE was surgically confirmed in rectosigmoid (n=88), vagina (n=21), rectovaginal septum (n=34), and uterosacral ligaments (n=156). RWC-TVS and SVG demonstrated similar sensitivity (SE; 93.8% vs 89.4%; p=0.210) and specificity (SP; 86.3% vs 79.4%; p=0.481) in diagnosing posterior DE. Specifically, both exams had similar accuracy in detecting nodules of uterosacral ligaments (p=0.779), vagina (p=0.688) and rectovaginal septum (p=0.824). RWC-TVS had higher SE (95.2% vs 82.0%; p=0.003) and similar SP (99.5% vs 98.5%; p=0.500) in diagnosing rectosigmoid endometriosis Accepted ArticleThis article is protected by copyright. All rights reserved and estimated better infiltration of intestinal submucosa (p=0.039), and distance between these nodule and anal verge (p < 0.001); only RWC-TVS allowed the estimation of bowel lumen stenosis. A similar proportion of discomfort was experienced during both exams (p=0.191), although a statistically higher mean VAS score was reported during RWC-TVS (p<0.001). Conclusions:Although RWC-TVS and SVG have similar accuracy in the diagnosis of DE, RWC-TVS has a higher performance in assessing the characteristics of rectosigmoid endometriosis.

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Are sonographers the future ‘gold standard’ in the diagnosis of endometriosis?

Deslandes,

Panuccio,

Avery

et al. 2024

Sonography

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Diagnosis of endometriosis has traditionally relied on laparoscopic surgery, which was considered the ‘gold standard’ diagnostic tool. This is not ideal as surgery carries risk, is expensive, is difficult to access, and disrupts patients work or education due to the recovery time needed. As such, imaging has been investigated as a potential method for non‐invasive diagnosis, with transvaginal ultrasound showing high diagnostic accuracy for ovarian endometriomas and deep endometriosis. The advances in imaging capability led to recent international guidelines suggesting laparoscopy is no longer the ‘gold‐standard’ for diagnosis and encouraging clinicians to utilise medical imaging as part of their diagnostic work‐up for endometriosis. Imaging is emerging as not only a tool for planning endometriosis surgery but increasingly as the first approach for initial diagnosis. Given that transvaginal ultrasound is the primary imaging modality for assessment of gynaecological conditions, it is inevitable that sonographers will have a significant future role in endometriosis diagnosis. This moves away from endometriosis diagnosis being the exclusive realm of laparoscopic surgeons and increasingly involves medical imaging specialists. This review article will describe the origins of endometriosis ultrasound and the current capabilities of transvaginal ultrasound in this field. The expectations of sonographers in this evolving space will be explored, as well as recent novel research findings to gain insight into what the future of endometriosis diagnosis with ultrasound may look like.

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Sliding sign and gel sonovaginography: A sneak peek prior to laparoscopy in patients with endometriosis

Cited by 6 publications

References 8 publications

Chronic pelvic pain: An underrecognised perioperative consideration

Chronic pelvic pain: An underrecognised perioperative consideration

A prospective study comparing rectal water contrast‐transvaginal ultrasonography with sonovaginography for the diagnosis of deep posterior endometriosis

Are sonographers the future ‘gold standard’ in the diagnosis of endometriosis?

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