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The recurrence of deep infiltrating endometriosis (DIE) after its surgical excision is a big problem: postoperative treatment is crucial. To compare two postoperative treatments: Dienogest and GnRH agonists. Prospective Randomized Controlled Trial (RCT). 146 women submitted to laparoscopic eradication of DIE with bowel and parametrial surgery. Patients were randomized into two groups. Group A (n = 81) received Triptorelin or Leuprorelin 3.75 mg every 4 weeks for 6 months. Group B (n = 65) received Dienogest 2 mg/day for at least 6 months. A first interview made after six months valued compliance to therapy, treatment tolerability, pain improvement, and side effects. A second interview at 30 ± 6 months valued pain relapse, imaging relapse, and pregnancy rate. The primary outcome was to demonstrate the non-inferiority of Dienogest about the reduction in pain recurrence. Secondary outcomes were differences in terms of treatment tolerability, side effects, imaging relapse rate, and pregnancy rate. Both Dienogest and GnRH agonists were associated with a highly significant reduction of pain at 6 and 30 months, without any significant difference (p <.001). About treatment tolerability, a more satisfactory profile was reported with Dienogest (p =.026). No difference in terms of clinical relapse, imaging relapse, and live births was found. Dienogest has proven to be as effective as GnRH agonists in preventing recurrence of DIE and associated pelvic pain after surgery. Also, it is better tolerated by patients. [ABSTRACT FROM AUTHOR]

Recurrence of endometriosis after conservative surgery is not an uncommon finding. There is no uniformity, however, on what the term 'recurrence' means. Recurrence is variously defined in the literature as the relapse of pain, clinical or instrumental detection of an endometriotic lesion, repeat rise in CA 125 levels, or evidence of recurrence found during repeat surgery. Consequently, the reported recurrence rate varies widely (0-89%) in the different series, depending on its definition and the type of study performed. As endometriosis recurrence seems to be an indeterminate enemy, we set out to examine exactly what we were fighting in our everyday battle. In this narrative review, we aimed to seek an answer to questions related to endometriosis recurrence, some of which are often asked by our patients. [ABSTRACT FROM AUTHOR]

Background: Nerve-sparing (NS) surgery reduces bowel, bladder and sexual dysfunction without decreasing surgical efficacy. Objectives: This study aimed to summarize the anatomical and surgical data of NS technique and to review the post-operative outcomes after NS surgery for deeply infiltrating endometriosis (DIE). Data sources: Data were collected from published research articles from MEDLINE and the Cochrane Library databases. Conclusions, implications of key findings: The NS technique approach for DIE seems to be feasible and reproductive. In comparison to the conventional surgery (CS), it seems to demonstrate better preservation of pelvic visceral function and an improvement in quality of life with same recurrence rates. The concept of preservation of autonomic nerves during surgical treatment of DIE should become standard in reference center. [ABSTRACT FROM AUTHOR]

Fibromatosis is the most frequent benign uterine pathology of fertile women, rarely causing anomalous enlargement of the uterus. Traditionally the surgical treatment has been abdominal hysterectomy. However, development of minimally invasive techniques has led to major safeness of the laparoscopic route. We report a case of total laparoscopic hysterectomy performed on a uterus weighting more than 3,000 g and present a review of the literature about the laparoscopic approach to very enlarged uteri. [ABSTRACT FROM AUTHOR]

Background: V-betaLH is a common genetic variant of LH caused by two polymorphic base changes in the beta subunit gene, altering the amino acid sequence (Trp8Arg and Ile15Thr). In a previous-preliminary trial performed in women undergoing IVF, it was demonstrated that carriers of v-betaLH show sub-optimal ovarian response to a standard long GnRH-agonist down -regulation protocol when stimulated with pure recombinant FSH (r-hFSH). The aim of this study was to confirm the hypothesis that women with v-betaLH display hypo-sensitivity to exogenous FSH in a larger IVF population and to explore the frequency of this variant in a Danish female population. Methods: In the present study, the effect of v-betaLH was retrospectively investigated in a larger series of women undergoing controlled ovarian stimulation (COS) and, for the first time, in a Danish IVF population. A total of 220 normogonadotrophic women following a long GnRH-agonist down-regulation protocol received an individualized dose of r-hFSH (100 IU and 375 IU s.c. daily) according to antral follicle count, baseline FSH, body mass index and age. The LH genotype was assessed in all patients by immunofluorometric assay. Results: V-betaLH was present in 11% of patients, whereas the allelic frequency was 12%. The study population was divided into two groups according to their LH genotype. Group A consisted of 196 wt/wt women. Group B included 24 individuals with v-betaLH (21 heterozygous and 3 homozygous). No statistically significant differences in the mean number of oocytes retrieved, fertilization rate and pregnancy rate per cycle wereobserved between groups. However, Group B received a significantly higher cumulative-dose of r-hFSH than Group A (2435.86 +/- 932.8 IU versus 1959.8 +/- 736.45 p = 0.048). When one-way ANOVA in a within design was applied, the LH genotype had a statistically significant effect (p<0.01) on the cumulative dose of r-hFSH, showing a progressive increase from wt/wt (1959.8 +/- 736.45 IU) to v-betaLH hetero- (2267.5 +/- 824.3) and homozygotic women (3558.3 +/- 970.9). Conclusions: These results confirm that carriers exhibit hypo-sensitivity to exogenous FSH during COS, documenting that the frequency of v-betaLH in Denmark is similar to a number of European countries. [ABSTRACT FROM AUTHOR]

Some studies have suggested a possible role of leptin, an active cytokine produced by adipocytes, in the pathogenesis of pelvic endometriosis. The present study was designed to assess leptin levels in the peritoneal fluid (PF) of women with the 'deep' or 'superficial' types of ovarian endometriosis. Twenty-seven women with a single ovarian endometrioma having a mean diameter between 3 and 5 cm were included in the study. Patients were divided into two groups according to the type of ovarian endometriosis: Group A (n = 11) consisted of women with 'superficial' endometriomas located at the ovarian surface; Group B (n = 16) included patients with 'deep' intra-ovarian endometriomas. Women undergoing laparoscopy for unexplained infertility and not affected by pelvic and/or ovarian endometriosis were considered as controls (Group C, n = 10). Patients with an ovarian endometrioma had significantly increased PF leptin concentrations than endometriosis-free controls (Groups A and B vs. Group C, p < 0.01). Patients with 'superficial' endometriomas had significantly higher PF leptin levels compared with patients with 'deep' endometriomas (Group A vs. B, p < 0.01). This difference remained significant after correction for the BMI; moreover, a positive correlation between PF leptin and BMI was observed in Groups B and C, but not in women with 'superficial' endometrioma (Group A). Our observations suggest that: (a) leptin could play an active role in promoting the development of 'superficial' ovarian endometriomas and (b) 'superficial' and 'deep' ovarian endometriomas could have a different pathogenesis. [ABSTRACT FROM AUTHOR]

Various studies have compared the efficacy of GnRH agonists (GnRH-a) and antagonists (GnRH-ant) for controlled ovarian stimulation (COS) in women undergoing IVF. Nevertheless, few data are available about the use of GnRH-ant in poor responders. Here, a flexible protocol providing a gradual increase in the dose of GnRH-ant in association with recombinant LH (rec-LH) administration is compared with the standard GnRH-a flare-up protocol in 133 women at risk for poor ovarian response. The mean number of metaphase 2 oocytes (primary end point) was significantly higher in the antagonist group (5.73 ± 3.57 vs. 4.64 ± 2.23, respectively; P<.05). [Copyright &y& Elsevier]

Over the last twenty years, segmental resection (SR) has been the technique most frequently used to treat bowel endometriosis. Nowadays, it is most commonly performed by laparoscopy; however, there is evidence that it can be safely performed by robotic-assisted laparoscopic surgery. Rectovaginal fistula and anastomotic leakage are the two major complications of SR; other complications include pelvic abscess, postoperative bleeding, ureteral damage, and anastomotic stricture. Several studies showed that SR causes improvement in pain and intestinal symptoms; nerve-sparing SR may improve the functional outcomes. The rates of postoperative recurrence of bowel endometriosis vary across the studies, possibly because of the different definitions of recurrence., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aim: To analyze pelvic dysfunctions, quality of life, and survival after nerve-sparing radical hysterectomy (NSRH) compared to classical radical hysterectomy (RH) for cervical cancer., Patients and Methods: All cervical cancer patients undergoing a RH or a NSRH were evaluated for pelvic dysfunctions and filled in a quality-of-life questionnaire., Results: A total of 56 women were included; 31 underwent RH (group 1) and 25 NSRH (group 2). Postoperatively, a higher number of patients had urinary incontinence (p=0.02), urinary retention (p=0.01), faecal incontinence (p=0.01) and constipation (p=0.01) in group 1 versus group 2. Patients referred a higher rate of severe sexual dysfunction after RH compared to NSRH (p=0.03). No differences were found in orgasmic frequency and sexual desire; overall quality of life evaluation was more satisfactory after NSRH., Conclusion: NSRH conferred a better clinical outcome with fewer long-term bladder, colorectal and sexual complications. Post-operative quality of life after NSRH was better, with the same overall survival as compared to RH.