[Combined treatment of endometriosis: radical yet gentle].
Aktuelle Urol. 2018 Feb;49(1):60-72
Authors: Alkatout I, Wedel T, Maass N
Endometriosis is the second most typical benign feminine genital illness after uterine myoma. This evaluate discusses the administration of particular person sufferers. This could take into consideration the severity of the illness and whether or not the affected person needs to have youngsters. Explicit emphasis is laid on the anatomical intersections which, when injured, can result in persistent injury of the anterior, center or posterior compartment and will not be sometimes the reason for urological and urogynaecological follow-up measures. Typical signs of endometriosis embrace continual pelvic ache, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder signs (e.?g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), irregular menstrual bleeding, continual fatigue and low again ache. Approx. 50?% of all feminine youngsters and as much as 32?% of all ladies of reproductive age who’ve been operated for continual pelvic ache or dysmenorrhoea endure from endometriosis. The time interval between the primary unspecific signs and the medical prognosis of endometriosis is about 7 years. That is precipitated not solely by the non-specific nature of the signs but additionally by the frequent lack of information on the a part of the cooperating disciplines with which the sufferers have first contact. Because the pathogenesis of endometriosis shouldn’t be clearly understood, causal remedy continues to be inconceivable. Remedy choices embrace expectant administration, analgesia, hormonal medical remedy, surgical intervention and the mix of medical remedy earlier than and/or after surgical procedure. The remedy must be as radical as vital and as minimal as potential. The recurrence charge amongst handled sufferers lies between 5?% and?>?60?% and could be very a lot depending on built-in administration and surgical abilities. Consequently, to optimise the person affected person’s remedy, a excessive diploma of interdisciplinary cooperation in prognosis and remedy is essential and must be reserved to applicable centres?-?particularly within the case of deep infiltrating endometriosis.
PMID: 29390219 [PubMed – in process]