Ureteral endometriosis, the hidden enemy: multivariable fractional polynomial approach for evaluation of preoperative risk factors in the absence of ureteral dilation

Arena, Alessandro; Forno, Simona Del; Orsini, Benedetta; Iodice, Raffaella; Esposti, E. Degli; Aru, Anna Chiara; Manzara, Federica; Lenzi, Jacopo; Raimondo, Diego; Seracchioli, Renato

doi:10.1016/j.fertnstert.2021.03.027

Cited by 14 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In their study, Roman et al [24] found that DE infiltrating the rectosigmoid was associated with ureteral endometriosis surgery in 11.9% patients. Furthermore, our findings suggest an association between rectovaginal nodule size and ureteral involvement, confirming the data previously published by Arena et al [8] which found that the diameter of posterior DE nodule was significantly correlated with the probability of UE. Donnez and al.…”

Section: Discussionsupporting

confidence: 93%

“…DE is defined by endometriotic infiltration under the peritoneum of > 5 mm or involvement of viscera, such as the uterus, vagina, rectum, bladder, or ureter [2], regardless of the depth of penetration [3,4]. Ureteral endometriosis (UE) is a rare entity but is now increasingly recognized and has been reported to occur in 10 to 48 % of women affected by DE [5][6][7][8]. It can be divided into two forms, extrinsic (80%) and intrinsic (20%) [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

Donval

Niro

Gaillard

et al. 2022

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

Donval

Niro

Gaillard

et al. 2022

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

show abstract

“…Arena et al 40 reported that factors such as previous endometriosis surgery, the presence of adenomyosis and parametrial location may increase the risk of intraoperative or postoperative complications in cases of ureteral endometriosis surgery. In our study all the factors that could contribute to a higher risk of complications (bowel and urinary surgery, previous endometriosis surgeries and operative time) were adjusted in the multivariate analysis in order to prevent bias.…”

Section: Discussionmentioning

confidence: 99%

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Gràcia

Guirior

Valdés-Bango

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Deep endometriosis (DE) occurs in 15–30% of patients with endometriosis and is associated with concomitant adenomyosis in around 25–49% of cases. There are no data about the effect of the presence of adenomyosis in terms of surgical outcomes and complications. Thus, the aim of the present study was to evaluate the impact of adenomyosis on surgical complications in women with deep endometriosis undergoing laparoscopic surgery. A retrospective cohort study including women referred to the endometriosis unit of a referral teaching hospital. Two expert sonographers preoperatively diagnosed DE and adenomyosis. DE was defined according to the criteria of the International Deep Endometriosis Analysis group. Adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien–Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. 157 DE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.50% (noA group) (p < 0.001). Multivariate analysis showed a 4.56-fold increased risk of presenting complications in women with adenomyosis (CI 1.90–11.30; p = 0.001) independently of undergoing hysterectomy. There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p < 0.001). Adenomyosis is an independent preoperative risk factor for surgical complications in DE surgery after adjustment for known demographic, clinical and surgical risk factors.

show abstract

“…Unlike bladder endometriosis, ureteral endometriosis is often asymptomatic and can lead to silent hydronephrosis and loss of renal function [35]. Ultrasound can easily diagnose ureteric dilatation and hydronephrosis, leading to the suspicion of ureteric deep endometriosis but diagnosis can be challenging in cases of extrinsic compression without stenosis [35–37]. Figure 4 shows uterosacral deep endometriosis with adjacent hydroureter and its corresponding surgical findings.…”

Section: Uretermentioning

confidence: 99%

“…Jurkovic and coworkers state that the pelvic ureter can be identified in almost all women on ultrasound and published a step-by-step guide for the identification and assessment of the distal ureters on ultrasound [37]. In 2021, Arena et al [35] published a mathematical model predicting deep endometriosis preoperatively based on history of previous endometriosis surgery and ultrasound findings of parametrial involvement, posterior deep endometriosis nodule size and presence of adenomyosis. Preoperative diagnosis of ureteric involvement is important for surgical planning and the utilization of a multidisciplinary team including advanced laparoscopic gynaecologist, general surgeon and urologist [35].…”

Section: Uretermentioning

confidence: 99%

Effectiveness of ultrasound for endometriosis diagnosis

Chen-Dixon

Uzuner

Mak

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Purpose of reviewEndometriosis is a chronic benign gynaecological condition characterized by pelvic pain, subfertility and delay in diagnosis. There is an emerging philosophical shift from gold standard histopathological diagnosis through laparoscopy to establishing diagnosis through noninvasive imaging.Recent findingsThe ENZIAN classification system was updated in 2021 to be suitable for both diagnostic imaging and laparoscopy. The accuracy of transvaginal ultrasound (TVUS) in diagnosing endometriosis varies depending on location of the lesion. A recent international pilot study found that when ultrasound is performed in accordance with the IDEA consensus, a higher detection of deep endometriosis is seen, with an overall sensitivity of 88% and specificity of 79% compared with direct surgical visualization.SummaryAlthough ultrasound can detect adenomyosis, deep endometriosis and endometriomas, it is not possible to reliably detect superficial endometriosis. In the instance of a negative ultrasound with persistence of symptoms despite medical therapy, laparoscopy should be considered for diagnosis and treatment.

show abstract

Ureteral endometriosis, the hidden enemy: multivariable fractional polynomial approach for evaluation of preoperative risk factors in the absence of ureteral dilation

Cited by 14 publications

References 30 publications

Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Effectiveness of ultrasound for endometriosis diagnosis

Contact Info

Product

Resources

About