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Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(11):729-744
, , , , To review the current state of knowledge on the impact of the surgical treatment on the sexual function and dyspareunia of deep endometriosis patients.
A systematic review was conducted in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted systematic searches in the PubMed, EMBASE, LILACS, and Web of Science databases from inception until December 2022. The eligibility criteria were studies including: preoperative and postoperative comparative analyses; patients with a diagnosis of deep endometriosis; and questionnaires to measure sexual quality of life.
Two reviewers screened and reviewed 1,100 full-text articles to analyze sexual function after the surgical treatment for deep endometriosis. The risk of bias was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Collaboration's tool for randomized controlled trials. The present study was registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration CRD42021289742).
General variables about the studies, the surgical technique, complementary treatments, and questionnaires were inserted in an Microsoft Excel 2010 (Microsoft Corp., Redmond, WA, United States) spreadsheet.
We included 20 studies in which the videolaparoscopy technique was used for the excision of deep infiltrating endometriosis. A meta-analysis could not be performed due to the substantial heterogeneity among the studies. Classes III and IV of the revised American Fertility Society classification were predominant and multiple surgical techniques for the treatment of endometriosis were performed. Standardized and validated questionnaires were applied to evaluate sexual function.
Laparoscopic surgery is a complex procedure that involves multiple organs, and it has been proved to be effective in improving sexual function and dyspareunia in women with deep infiltrating endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(11):729-744
, , , , To review the current state of knowledge on the impact of the surgical treatment on the sexual function and dyspareunia of deep endometriosis patients.
A systematic review was conducted in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted systematic searches in the PubMed, EMBASE, LILACS, and Web of Science databases from inception until December 2022. The eligibility criteria were studies including: preoperative and postoperative comparative analyses; patients with a diagnosis of deep endometriosis; and questionnaires to measure sexual quality of life.
Two reviewers screened and reviewed 1,100 full-text articles to analyze sexual function after the surgical treatment for deep endometriosis. The risk of bias was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Collaboration's tool for randomized controlled trials. The present study was registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration CRD42021289742).
General variables about the studies, the surgical technique, complementary treatments, and questionnaires were inserted in an Microsoft Excel 2010 (Microsoft Corp., Redmond, WA, United States) spreadsheet.
We included 20 studies in which the videolaparoscopy technique was used for the excision of deep infiltrating endometriosis. A meta-analysis could not be performed due to the substantial heterogeneity among the studies. Classes III and IV of the revised American Fertility Society classification were predominant and multiple surgical techniques for the treatment of endometriosis were performed. Standardized and validated questionnaires were applied to evaluate sexual function.
Laparoscopic surgery is a complex procedure that involves multiple organs, and it has been proved to be effective in improving sexual function and dyspareunia in women with deep infiltrating endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):568-574
DOI 10.1590/S0100-72032012001200007
PURPOSE: To evaluate the expression of neurotrophic (NGF, NPY and VIP) and pro-inflammatory (TNF-α) mediators in the rectum and sigmoid fragments compromised by endometriosis. METHODS: Twenty-four patients were selected to undergo surgical treatment of endometriosis of the rectum and sigmoid colon with a segmental resection technique, followed by end-to-end anastomosis with a circular stapler from January 2005 to December 2007. The study included premenopausal women who underwent surgical treatment for deep endometriosis infiltrating the rectum with involvement of the rectum and sigmoid, reaching the level of the muscle layer, submucosa or mucosa. Twenty-four rectum and sigmoid fragments with histologically confirmed endometriosis, one from each of the 24 selected patients, were used for the study group. For the control group, we used a fragment of the distal resection margin called anastomosis ring from each of the 24 patients enrolled in the study. Samples were grouped into Tissue Micro Array (TMA) blocks and subjected to immunohistochemistry to evaluate the expression of tumor necrosis factor alpha (TNF-α), nerve growth factor (NGF), neuropeptide Y (NPY) and P vasoactive intestinal peptide (VIP), followed by semiquantitative analysis of immunostaining by reading the relative optical density (OD). RESULTS: There was higher optical density relative to TNF-α immunostaining and NGF in the study group (samples with intestinal endometriosis), DO=0.01, for the two proteins, respectively (p<0.05), compared to controls without endometriosis. There was no statistically significant difference in the optical density of immunostaining of NPY and VIP. CONCLUSION: We identified increased immunostaining of TNF-α antibodies and fragments of NGF in the rectum and sigmoid compromised by endometriosis compared to disease-free controls. We did not identify any statistical difference in immunostaining of NPY and VIP proteins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):568-574
DOI 10.1590/S0100-72032012001200007
PURPOSE: To evaluate the expression of neurotrophic (NGF, NPY and VIP) and pro-inflammatory (TNF-α) mediators in the rectum and sigmoid fragments compromised by endometriosis. METHODS: Twenty-four patients were selected to undergo surgical treatment of endometriosis of the rectum and sigmoid colon with a segmental resection technique, followed by end-to-end anastomosis with a circular stapler from January 2005 to December 2007. The study included premenopausal women who underwent surgical treatment for deep endometriosis infiltrating the rectum with involvement of the rectum and sigmoid, reaching the level of the muscle layer, submucosa or mucosa. Twenty-four rectum and sigmoid fragments with histologically confirmed endometriosis, one from each of the 24 selected patients, were used for the study group. For the control group, we used a fragment of the distal resection margin called anastomosis ring from each of the 24 patients enrolled in the study. Samples were grouped into Tissue Micro Array (TMA) blocks and subjected to immunohistochemistry to evaluate the expression of tumor necrosis factor alpha (TNF-α), nerve growth factor (NGF), neuropeptide Y (NPY) and P vasoactive intestinal peptide (VIP), followed by semiquantitative analysis of immunostaining by reading the relative optical density (OD). RESULTS: There was higher optical density relative to TNF-α immunostaining and NGF in the study group (samples with intestinal endometriosis), DO=0.01, for the two proteins, respectively (p<0.05), compared to controls without endometriosis. There was no statistically significant difference in the optical density of immunostaining of NPY and VIP. CONCLUSION: We identified increased immunostaining of TNF-α antibodies and fragments of NGF in the rectum and sigmoid compromised by endometriosis compared to disease-free controls. We did not identify any statistical difference in immunostaining of NPY and VIP proteins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):400-405
DOI 10.1590/S0100-72032008000800005
PURPOSE: to evaluate the sensitivity, specificity, positive and negative predictive value of double contrast barium enema (DCBE) for the diagnoses of rectum and sigmoid endometriosis. METHODS: prospective transversal study including 37 patients with suspicion of deep endometriosis. Patients were submitted to DCBE, according to the standard technique described in the literature, and then, to laparoscopy. The results of laparoscopy and the DCBE images were interpreted and compared, based on the histological evaluation. Statistical analysis was done by association (χ2 test) and agreement analyses (Kappa's test). RESULTS: patients' average age was 35.8±4.4 years old (age group from 28 to 48 years), 85.6% of them being white and 14.4%, black women. Deep endometriosis was confirmed by laparoscopy and histological exam in all the studied patients. Intestinal endometriosis was confirmed by histological exam in 27 women (72.9%) of them. DCBE demonstrated suggestive radiologic signs of intestinal infiltration by endometriosis in 24 women (64.9%) and no signs in 13 women (35.1%). The method sensitivity was 67.5%, specificity 53.8%, positive predictive value, 77.8% and negative predictive value, 70%. Among the 24 abnormal exams, 16 (43.2%) presented radiologic speculum-type image, 16 (43.2%), an image compatible with stenosis, and four (10.8%), double contour. CONCLUSIONS: the DCBE presents high sensitivity and high positive predictive value, in the diagnosis of the rectum and sigmoid endometriosis. Radiologic images speculum and stenosis-type present high sensitivity and positive predictive value for the intestinal infiltration by endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):400-405
DOI 10.1590/S0100-72032008000800005
PURPOSE: to evaluate the sensitivity, specificity, positive and negative predictive value of double contrast barium enema (DCBE) for the diagnoses of rectum and sigmoid endometriosis. METHODS: prospective transversal study including 37 patients with suspicion of deep endometriosis. Patients were submitted to DCBE, according to the standard technique described in the literature, and then, to laparoscopy. The results of laparoscopy and the DCBE images were interpreted and compared, based on the histological evaluation. Statistical analysis was done by association (χ2 test) and agreement analyses (Kappa's test). RESULTS: patients' average age was 35.8±4.4 years old (age group from 28 to 48 years), 85.6% of them being white and 14.4%, black women. Deep endometriosis was confirmed by laparoscopy and histological exam in all the studied patients. Intestinal endometriosis was confirmed by histological exam in 27 women (72.9%) of them. DCBE demonstrated suggestive radiologic signs of intestinal infiltration by endometriosis in 24 women (64.9%) and no signs in 13 women (35.1%). The method sensitivity was 67.5%, specificity 53.8%, positive predictive value, 77.8% and negative predictive value, 70%. Among the 24 abnormal exams, 16 (43.2%) presented radiologic speculum-type image, 16 (43.2%), an image compatible with stenosis, and four (10.8%), double contour. CONCLUSIONS: the DCBE presents high sensitivity and high positive predictive value, in the diagnosis of the rectum and sigmoid endometriosis. Radiologic images speculum and stenosis-type present high sensitivity and positive predictive value for the intestinal infiltration by endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):153-157
DOI 10.1590/S0100-72032007000300007
Dermatofibrosarcoma protuberans (DFSP) is a rare malignant neoplasia in gynecology, with probability of recurrence and low possibilities of metastasis. A 34-year-old patient after endometriosis treatment presented pain in the left inguinal region. She reported sensation of gradual increase in a solid nodule, painless at palpation, with difficult mobilization. Exeresis was proceeded with diagnostic hypothesis of endometriosis. Microscopy revealed a mesenchymal neoplasia characterized by proliferation of monomorphic fusiform cells and storiform aspect characterizing the DFSP.DFSP must be remembered in the differential diagnosis of the affections of the inguinal region in gynecology because it represents a malignant neoplasia, although it's rare.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):153-157
DOI 10.1590/S0100-72032007000300007
Dermatofibrosarcoma protuberans (DFSP) is a rare malignant neoplasia in gynecology, with probability of recurrence and low possibilities of metastasis. A 34-year-old patient after endometriosis treatment presented pain in the left inguinal region. She reported sensation of gradual increase in a solid nodule, painless at palpation, with difficult mobilization. Exeresis was proceeded with diagnostic hypothesis of endometriosis. Microscopy revealed a mesenchymal neoplasia characterized by proliferation of monomorphic fusiform cells and storiform aspect characterizing the DFSP.DFSP must be remembered in the differential diagnosis of the affections of the inguinal region in gynecology because it represents a malignant neoplasia, although it's rare.
