Abbas Aflatoonian , Nasim Tabibnejad,
Volume 18, Issue 11 (11-2020)
Abstract
Background: Endometrioma is a common high-recurrence gynecological disease that affects infertility. Surgical resection using laparotomy or laparoscopy is applied as a standard treatment. Moreover, sclerotherapy is reported to be effective as a non-invasive method for treating endometrioma.
Objective: To evaluate whether the ethanol retention or aspiration after sclerotherapy improve pregnancy outcome in infertile women with endometrioma.
Materials and Methods: In a retrospective study, hospital records of 43 women with recurrent or bilateral endometrioma who had been undergone transvaginal ultrasound sclerotherapy were reviewed. They were selected to receive either ethanol for 10 min, ethanol injection, irrigation, and then aspiration or total retention without aspiration based on the surgeon’s decision. The participants were followed-up for 3, 6 and 12 months for natural or artificial conception as well as for cyst recurrence.
Results: Chemical pregnancy was positive in 52% of the women in the aspiration group and 53.8% in the retention group. Ongoing pregnancy (44% vs 46.2%, p = 0.584) and live birth (40% vs 46.2%, p = 0.490) were reported marginally higher in the retention group compared with the aspiration group, and the differences were not statistically significant. Moreover, the recurrence rate were found to be 48.1% and 37.5% in the aspiration and retention groups, respectively (p = 0.542). The cysts size in the retention group was significantly correlated to the recurrence rate.
Conclusion: Both the aspiration and left in situ of ethanol 95% sclerotherapy have the similar impact on the treatment of ovarian endometrioma regarding pregnancy and recurrence rate. However, larger randomized studies with strict inclusion criteria are needed.
Abolfazl Mehdizadeh, Shahla Chaichian, Shahla Mirgaloybayat, Samaneh Rokhgireh, Kobra Tahermanesh, Maryam Kadivar, Farahnaz Farzaneh,
Volume 20, Issue 1 (1-2022)
Abstract
Background: The first case of inguinal endometriosis was described by Cullen. Endometriosis in the round ligament could be in the pelvic or inguinal area and is a rare disease occurring in 0.6% of women. Women with inguinal endometriosis have a painful inguinal mass during menstrual cycles and they mostly have a history of surgery. The right side is more commonly involved in inguinal endometriosis than the left side (90-94%). A history of gynecologic or abdominal surgery is common in women with inguinal endometriosis.
Case presentation: In our case, a 39-yr-old virgin woman presented with localized pain in the right inguinal that had been present for 4 yr. She did not have any history of previous surgery, and abdominal ultrasonography showed a hypoechoic mass with minimal vascularity. Inguinal endometriosis was correctly diagnosed by two expert radiologists preoperatively, and she underwent laparoscopic surgery.
Conclusion: Considering inguinal endometriosis in the differential diagnosis of women with inguinal masses is important, even if there is no history of gynecologic or abdominal surgery.
Zahra Asgari, Reyhaneh Hosseini, Mahdi Sepidarkish, Azar Nabati,
Volume 20, Issue 5 (5-2022)
Abstract
Background: Early diagnosis and appropriate treatment of endometriosis are vital and may prevent subsequent complications.
Objective: To investigate the diagnostic accuracy of transvaginal ultrasound sonography (TVUS) and transrectal ultrasound sonography for detecting endometriosis considering the age and body mass index (BMI).
Materials and Methods: This was a retrospective cohort study of 119 women scheduled for surgery in a tertiary health care center for clinically suspected endometriosis. Married and virgin women underwent TVUS and transrectal ultrasound sonography, respectively, before laparoscopic excision of endometriotic lesions.
Results: The accuracy of TVUS in the diagnosis of right endometrioma in women with a normal BMI was superior to that in women with a BMI ≥ 30 (95.6% vs. 75.3%; p < 0.001). For the detection of left endometrioma in women with a normal BMI, TVUS demonstrated a sensitivity of 96.9% and a negative predictive value of 92.9%, which was significantly superior to TVUS in women with obesity (sensitivity: 77.4%, negative predictive value: 58.6%). The accuracy of TVUS in the diagnosis of left endometrioma in women under 35 yr was superior to that in women older than 35 yr (93.2% vs. 77.9%; p = 0.04). Similarly, the accuracy of TVUS in the diagnosis of right endometrioma in women under 35 yr was superior to TVUS in women older than 35 yr (86.5% vs. 73.3%; p = 0.04).
Conclusion: Ultrasound can be a useful technique for detecting endometriosis when used adjunctively with the patient’s history and physical findings, especially age and BMI.
Anahita Haghjoo, Rahil Haghjoo, Marzieh Rahimipour,
Volume 21, Issue 4 (4-2023)
Abstract
Background: Ovarian torsion (adnexal torsion) is a rare event in pediatric patients which is primarily managed by pediatric general surgeons.
Case presentation: This study presents a case of ovarian torsion in a 2-yr-old girl with a history of episodic lower abdominal pain, nausea, and vomiting for 2 days. Her physical examination was normal except for mild tenderness in the lower abdomen with no palpable mass. A color Doppler ultrasound was performed for further investigation, and an ovarian torsion was reported without sonographic signs of intussusception and acute appendicitis, so she underwent laparotomy. A relatively complete torsion was observed in the left ovarian pedicle. Initially, the left ovary and fallopian tube had a dark appearance, and 10-15% of the ovarian tissue was still normal. Detorsion of ovary was done and it was decided to preserve the ovary. After about 20 min, the color of ovary and fallopian tube returned to relatively normal, indicating normal blood flow. The patient was discharged 2 days later because a follow-up color Doppler ultrasound showed normal ovarian blood flow.
Conclusion: The possibility of ovarian torsion must be considered in all female infants with suspicious abdominal pain.
Ashraf Moini, Tayebeh Esfidani, Arezoo Arabipoor, Reihaneh Hosseini, Shima Mohiti (md.), Sakineh Noor Mohammadi,
Volume 21, Issue 11 (11-2023)
Abstract
Background: The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject.
Objective: To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures.
Materials and Methods: In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women's hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups.
Results: Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups.
Conclusion: Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.
Tahereh Poordast, Saeed Alborzi, Ziba Kiani, Navid Omidfar, Elham Askary, Kefayat Chamanara, Mansoureh Shokripour, Alimohammad Keshtvarz Hesam Abadi,
Volume 22, Issue 7 (7-2024)
Abstract
Background: The lack of improvement in some endometriotic people’s pain after surgery even while using hormone treatment may suggest an inappropriate response to routine hormonal therapies.
Objective: This study aimed to determine a cut-off point for selecting the most appropriate treatment based on the hormone receptors of endometriotic lesions.
Materials and Methods: In this cross-sectional study, by reviewing the medical records of participants and testing their archive samples and phone interviews (if needed), 86 symptomatic women after endometriosis surgery who were operated into governmental hospitals, Shahid Faghihi and Hazrate Zeinab Shiraz Iran were enrolled between March 2017 and March 2019. Women were divided into 2 groups: responsiveness (n = 73 for dysmenorrhea, n = 60 for dyspareunia) to medical treatment and surgery, and unresponsiveness (n = 13, n = 7). We examined the pathological slides of 86 women to determine the amount of hormone receptors and the relationship between the type of medical treatment and the level of hormone receptors on pain relief within 1 yr after surgery.
Results: Based on the receiver operating characteristic curve, dysmenorrhea in the presence of tissue estrogen receptors > 60% (p = 0.1065), and dyspareunia in the presence of tissue progesterone receptors > 80% (p = 0.0001) responded well to medical treatment after surgery. In the presence of endometrioma-dysmenorrhea showed the best response to oral contraceptive pills (69.4%), while in deep infiltrative endometriosis-dyspareunia showed the best response to progesterone treatment (75%).
Conclusion: Prescribing an appropriate hormone therapy based on a specific immunohistochemistry staining pattern can improve the life quality of postoperative endometriosis individuals.
