Deep Pelvic Endometriosis

Deep pelvic endometriosis is one of the most severe expressions of a disease that may involve all the pelvic organs – bladder, ureters, rectosigmoid colon – causing debilitating symptoms and leading to impaired quality of life in young women. The chapters cover both diagnostic and therapeutic aspects of this disease. The central role of diagnostic imaging in surgical decision making is highlighted, as well as the difficulties involved in careful planning of surgical treatment, and special attention is paid to minimally invasive techniques. The paramount importance of a multidisciplinary team, involving the expertise of radiologists, gastroenterologists, and psychologists, as well as the skills of the gynecologist, urologist, and colorectal surgeon is underlined throughout the text. Table of contents 1 Introduction 1.1 Definition, Prevalence, and Epidemiology 1.2 Pathogenesis 1.2.1 Retrograde Menstruation. 1.2.2 Altered Immunity. 1.2.3 Genetic Factors. 1.2.4 Gross and Microscopic Pathology. 1.2.5 Link to Cancer 1.3 Deep Endometriosis 1.4 Classification 2 Diagnosis 2.1 Clinical Features 2.2 Symptoms 2.3 Physical Findings 2.4 Serum Markers 2.5 Laparoscopy 2.6 Instrumental Diagnosis 2.6.1 Abdominal Ultrasonography. 2.6.2 Transvaginal Sonography. 2.6.3 Rectal Water-contrast Transvaginal Sonography. 2.6.4 Sonovaginography. 2.6.5 “Tenderness-guided” Ultrasonography. 2.6.6 Three-dimensional Ultrasonography. 2.6.7 Endoscopic Transrectal Ultrasonography. 2.6.8 Magnetic Resonance Imaging. 2.6.9 Colonoscopy. 2.6.10 Double-contrast Barium Enema. 2.6.11 Computerized Tomography. 2.6.12 Cystoscopy. 2.6.13 Intravenous Pyelography. 2.6.14 Ureteroscopy 2.7 Conclusion 3 Treatment 3.1 Medical Therapy 3.1.1 Combined Treatment Approaches (Pharmacotherapy and Pain Therapy). 3.1.2 Experimental Treatment Approaches 3.2 Surgery 3.2.1 Laparoscopic Uterosacral Nerve Ablation. 3.2.2 Presacral Neurectomy. 3.2.3 Deep Pelvic Infiltration of the Rectovaginal Septum Without Intestinal Involvement. 3.2.3.1 Surgical Technique. 3.2.4 Deep Infiltrating Endometriosis With Rectal or Rectosigmoid Involvement. 3.2.4.1 Surgical Technique: Laparoscopic Bowel Resection. 3.2.5 Urinary Tract Endometriosis. 3.2.5.1 Bladder Endometriosis. 3.2.5.2 Ureteral Endometriosis. 3.2.5.3 Kidney Endometriosis. 3.2.5.4 Urethral Endometriosis. 3.2.6 Repetitive Conservative Surgery. 3.2.7 Definitive Surgery 4 The Experience of Living with Endometriosis 4.1 Introduction 4.2 Diagnosis of Endometriosis 4.2.1 Delay in Diagnosis. 4.2.2 Impact of a Diagnosis of Endometriosis. 4.2.3 Pain 4.3 Sexuality 4.3.1 Dyspareunia 4.3.2 Fertility 4.4 Uncertainty 4.5 Impact on Social Life and Relationships 4.6 Interactions with Health Professionals 4.7 Treatments 4.8 Summary