History of Uterine Surgery Is Not Associated With an Increased Severity of Bladder Deep Endometriosis

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• 作者：Louis Marcellin ; MD ; PhD^a ; ^b ; ^c ; Cé ; cile Morin ; MD^a ; ^b ; Pietro Santulli ; MD ; PhD^a ; ^b ; ^c ; Paul Marzouk ; MD^a ; ^b ; ^c ; Antoine Bourret ; MD^a ; Bertrand Dousset ; MD ; PhD^d ; Bruno Borghese ; MD ; PhD^a ; ^b ; Charles Chapron ; MD^a ; ^b ; ^c ; ^{charles.chapron@cch.aphp.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Bladder endometriosis ; Uterine surgery
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：23
• 期：7
• 页码：1130-1137
• 全文大小：596 K

文摘

To analyze whether a history of uterine surgery correlates with disease severity in patients with bladder deep infiltrating endometriosis (DIE).

Design

This was an observational, cross-sectional study using data collected prospectively (Canadian Task Force classification II-2).

Setting

A single university tertiary referral center.

Patients

We included all nonpregnant women younger than age 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient, a standardized questionnaire was completed during a face-to-face interview that was conducted by the surgeon in the month preceding the surgery.

Interventions

One hundred seven women with histologically proven bladder DIE were enrolled in this study. For the purpose of the study, the women were assigned to 2 groups before surgery: a study group that included women with a history of a scarred uterus (SU) (SU+, n = 16) and a control group that included women without SU (SU−, n = 99). Both groups were compared in terms of their general characteristics, medical histories, surgical findings, and the severity of the disease.

Measurements and Main Results

Patient age and body mass index were higher for the SU+ group as compared to the SU− group (37.9 ± 5.6 vs 32.2 ± 4.7, p < .01, and 24.7 ± 4.9 vs 21.9 ± 2.9, p = .03, respectively). Preoperative painful symptom scores did not differ between the 2 groups. No significant difference was observed in the rates of history for surgery for endometriosis (n = 11 [68.7%] vs n = 49 [53.8], p = .27). Comparison of the anatomic distribution of the lesions did not reveal a significant difference. The total American Society for Reproductive Medicine score did not differ between the groups (32.0 ± 34.4 vs 35.5 ± 34.5, p = .71). The incidence rate of isolated bladder DIE did not differ between the 2 study groups (n = 6 [37.5%] vs n = 40 [43.9%], p = .79).

Conclusion

SU before surgery for endometriosis was observed in 14.9% of cases of bladder DIE; however, this was not related to an increased severity of the disease. This observational study hence does not appear to support the pathophysiologic hypothesis of a transmyometrial source for bladder DIE.