By Paola De Nardi, Stefano Ferrrari, Elaine Denny
Deep pelvic endometriosis is without doubt one of the so much serious expressions of a affliction which can contain the entire pelvic organs – bladder, ureters, rectosigmoid colon – inflicting debilitating indicators and resulting in impaired caliber of existence in younger women.
The chapters conceal either diagnostic and healing facets of this illness. The vital position of diagnostic imaging in surgical selection making is highlighted, in addition to the problems curious about cautious making plans of surgical operation, and particular awareness is paid to minimally invasive techniques.
The paramount significance of a multidisciplinary group, related to the services of radiologists, gastroenterologists, and psychologists, in addition to the talents of the gynecologist, urologist, and colorectal health care provider is underlined during the text.
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Additional info for Deep Pelvic Endometriosis: A Multidisciplinary Approach
Fertil Steril 2010;93:1741–1744 Crosignani PG, Vercellini P. Conservative surgery for severe endometriosis: should laparotomy be abandoned definitively? Hum Reprod 1995;10:2412–2418 Abrao SM, Gonçalves MO, Antonio Dias J et al. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 2007;22:3092–3097 Marc Bazot, Clarisse Lafont, Roman Rouzier et al. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis.
12 Cystoscopy Cystoscopy is recommended for all patients with endometriosis and lower urinary tract symptoms or haematuria, since it represents one of the most cost-effective tests [32, 50–52]. The macroscopic appearance of bladder endometrioma lesions may change with the phases of the menstrual cycle; they are often edematous and irregular, with different shapes and colors: blue-red, blue-black, or blue-brown lesions are the most common findings 40 P. De Nardi, S. 15 Cystoscopic appearance of bladder endometrioma.
High-contrast resolution, multiplanarity, and greater field of view are the main advantages of MRI. On the other hand, a limitation of MRI is that some intestinal nodules may contain extensive fibrosis , which can be viewed as iso-intense to the muscle in both T1- and T2-weighted images. Another limitation is the duration of the examination, which may be altered by artefacts due to intestinal peristaltic movements. For this reason, most authors perform an intravenous injection of antispasmodic drug to limit bowel peristalsis.