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Preoperative and Postoperative Clinical and Transvaginal Ultrasound Findings of Adenomyosis in Patients With Deep Infiltrating Endometriosis

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Abstract

Objectives

Deep infiltrating endometriosis (DIE) represents the most complex form of endometriosis and its treatment is still challenging. The coexistence of DIE with other appearances of endometriosis stimulates new studies to improve the preoperative diagnosis. Adenomyosis is a clinical form that shares several symptoms with DIE. The present study investigated the possible presence of adenomyosis in a group of women with DIE and its impact on pre- and postoperative symptoms.

Materials and Methods

A group of women (n = 121) undergoing laparoscopic treatment for DIE were enrolled. Clinical and ultrasound evaluations were performed as preoperative assessment. The ultrasonographical appearances of DIE and of adenomyosis were recorded by 2-dimensional ultrasound. The following symptoms were considered: dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel, and urinary symptoms. Pain was evaluated by the visual analog scale system and menstrual bleeding was assessed by the use of the pictorial blood assessment chart. In a subgroup of women (n = 55), a follow-up evaluation (3-6 months after surgery) was done.

Results

A relevant number of patients with DIE showed adenomyosis (n = 59; 48.7%); in this group, dysmenorrhea (P = .0019), dyspareunia (P = .0004), and abnormal uterine bleeding (P < .001) were statistically higher than that in the group with only DIE. After surgery, painful symptoms improved in the whole group but remained significantly higher (P < .001) in the group with adenomyosis.

Conclusions

Deep infiltrating endometriosis is frequently associated with adenomyosis, significantly affecting pre- and postoperative symptoms and thus influencing the follow-up management.

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Author information

Authors and Affiliations

  1. Department of Molecular and Developmental Medicine, University of Siena, Viale Bracci, 53100, Siena, Italy

    Lucia Lazzeri MD, Claudia Tosti MD, Serena Pinzauti MD, Felice Petraglia MD, PhD & Errico Zupi MD

  2. Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy

    Alessandra Di Giovanni MD & Mario Malzoni MD

  3. Department of Obstetrics and Gynecology, University of Rome “Tor Vergata”, Roma, Italy

    Caterina Exacoustos MD, PhD

Authors
  1. Lucia Lazzeri MD
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  2. Alessandra Di Giovanni MD
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  3. Caterina Exacoustos MD, PhD
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Correspondence to Lucia Lazzeri MD.

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Lazzeri, L., Di Giovanni, A., Exacoustos, C. et al. Preoperative and Postoperative Clinical and Transvaginal Ultrasound Findings of Adenomyosis in Patients With Deep Infiltrating Endometriosis. Reprod. Sci. 21, 1027–1033 (2014). https://doi.org/10.1177/1933719114522520

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