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Voiding Dysfunction after Laparoscopic Surgery for Deep Infiltrating Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S128–S151 Measurements and Main Results: The incidence of postmenopausal endometriosis was 2.9% (36/645) in patients with endometriosis. The mean age was 55.86.2 years. The mean menopausal period was 80.653.5 months. The common preoperative symptoms were lower abdominal pain (38.9%, 22/36) and lower back pain (33.3%, 12/36). The mean BMI was 24.42.7 kg/m2. The mean preoperative CA 125 level was 33.850.3 U/mL. Postmenopausal endometriosis was primarily located in the peritoneums (63.9%, 23/36), followed by ovary (19.4%, 7/36). There was one case of vaginal endometriosis. In almost cases, surgical excision and ablation of endometriotic lesions with laparoscopic hysterectomy and bilateral salpingo-oophorectomy were done (86.1%, 31/36). Two cases were coexistent with ovarian cancer (clear cell and serous adenoca). There was no recurrence of endometriosis after primary treatment. Conclusion: Although rare, postmenopausal endometriosis without previous hormonal therapy can occur and be the cause of disturbing symptoms. Peripheral conversion to estrogen with obesity is not suggested as a main predisposing factor of postmenopausal endometriosis in our study. In contrast to other reports, peritoneum was more common site than ovary. Therefore, gynecologists should be aware of the possibility of postmenopausal endometriosis in symptomatic patients without ovarian mass. 468 Voiding Dysfunction after Laparoscopic Surgery for Deep Infiltrating Endometriosis Gabriel B, Nassif J, Barata S, Trompoukis P, Wattiez A. Gynecology, IRCAD, Strasbourg, Bas Rhin, France Study Objective: To evaluate the prevalence of complete urinary retentions following laparoscopic surgery for moderate and severe endometriosis. To report on the clinical outcome of these patients and to discuss potential intraoperative risk factors. Design: Retrospective analysis of 121 consecutive cases of endometriosis surgery with a mean follow up time of 30 months. Setting: Strasbourg University Hospitals and IRCAD/EITS. Patients: One hundred twenty one patients (mean age 30.4 yrs) who underwent laparoscopic surgery for moderate to severe pelvic endometriosis in 2007 and 2008, and presented postoperative urinary retention were eligible for this study. Intervention: In most cases a deep infiltrating endometriosis including bowel, bladder or ureteral infiltration was present. In addition, 31 patients were diagnosed with uni- or bilateral uterosacral ligament involvement. Whenever possible, a complete resection of endometriotic nodules was performed including bowel or bladder wall resection, partial excision, or mucosal skinning. Measurements and Main Results: We evaluated the prevalence of postoperative voiding dysfunction after this kind of surgery. Pre- and postoperative pain scores were assessed using visual analogous scale. Postoperative follow-up data including the assessment of bladder function are presented. Results are still ongoing. Conclusion: The preliminary data analysis revealed a considerable rate of postoperative urinary retentions after radical laparoscopic surgery for pelvic endometriosis. Interestingly, unilateral resection of uterosacral ligament nodules does not preclude the postoperative occurrence of voiding dysfunction. We discuss potential operative strategies for the prevention of long-term sequelae in these predominantly young women. 469 The Role of Mullerian Inhibiting Substance in Inducing Apoptosis in Ectopic Endometrium Karipcin SF,1 Fangxian L,1 Borahay M,1 Kilic SG,1 Ozpolat B,2 Gurates B.3 1Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas; 2Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas; 3Department of Obstetrics & Gynecology, Firat University, Firat, Turkey Study Objective: Mullerian inhibiting substance (MIS) is a 140 kDa homodimer glycoprotein, a member of TGF-B family, causes regression of Mullerian ducts in developing male embryos. MIS has been previously shown to arrest growth and induce apoptosis in ovarian, endometrial and
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cervical cancer cell lines. The aim of the study was to demonstrate the effect of MIS treatment on endometriosis cell lines through apoptosis and autophagy. Design: Endometriosis cell lines treated with MIS, following the treatments growth inhibition, apoptosis and autophagy was measured. Setting: UTMB Obstetrics and Gynecology Research Laboratories. Intervention: Cultured CRL-7566 endometriosis cell lines from ovarian cyst (ATCC, Manassas, VA) were harvested at 80% confluency and placed in 96-well plates at 2000 cells per well. After 24 hours of incubation, each well was treated with human recombinant MIS (R&D Systems, Minneapolis, MN) at 10 mcg/mL, 5 mcg/mL, or with PBS as a buffer control. MIS and buffer control were added again after 4 days. Measurements and Main Results: MTT cell viability assay was performed on day 7. MIS caused dose-dependent inhibition in growth of endometriosis cell lines. Maximum inhibition of 50% was observed at 10mcg/mL MIS concentration followed by 44% growth inhibition at 5mcg/mL. Apoptosis was assessed by annexin V, by examining cell cycle analysis (sub-G1), and by PARP cleavage by Western blot. Cell lines treated with MIS at 10mcg/mL concentration showed 14.7% annexin positivity, as opposed to control group with 7.8% positivity.To detect and quantify acidic vesicular organelles, we stained cells with acridine orange. Autophagy was determined by fluorescence-activated cell sorting (FACS) analysis. MIStreated endometrial cell lines showed 24% autophagy compared with control group, which showed 60% autophagy. Conclusion: Our in vitro study revealed that MIS treatment induces apoptosis and cellular death in ectopic endometrial cells. We also revealed that MIS treatment inhibits basal autophagy in ectopic endometrial cells. 470 Is Pouch of Douglas (POD) Obliteration a Marker of Bowel Endometriosis? Khong S-Y, Bignardi T, Lam A, Luscombe G. Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia; Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia; Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia; Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia Study Objective: To assess predictive value of POD obliteration in the diagnosis of bowel endometriosis. Design: Prospective study between October 2004 and September 2008. Setting: University-affiliated tertiary referral centre for endometriosis. Patients: 454 consecutive women who underwent laparoscopic surgery for treatment of pelvic pain and/ or infertility-associated endometriosis. Intervention: Logistic regression analyses were performed to investigate the predictive value of POD obliteration at laparoscopy in regards to bowel endometriosis. Measurements and Main Results: 22.2% (101/454) of our sample population were found to have obliteration of the POD. Of these, 54.5% (55/101) required bowel shaving (67.3%), wedge (7.3%) or full segmental bowel resection (12.7%) or a combination of bowel procedures (12.7%). All had histological confirmation of bowel endometriosis. Of the remaining 46 women, 90.2% had endometriosis confirmed elsewhere in the pelvis. Conclusion: Obliteration Pouch of Douglas is a strong predictor of bowel endometriosis (p\0.001). Surgery in these cases are highly challenging with significant associated risks therefore clinicians may consider referring these patients to a dedicated endometriosis centre with multidisciplinary expertise for further management. 471 Post-Operative Use of Oral Contraceptives for Prevention of Endometrioma Recurrence after Laparoscopic Excision: Efficacy and Compliance Difficulties Kobori H, Watari A, Kumakiri Y, Nagai F, Yamamoto T. Koshigaya Municipal Hospital, Koshigaya, Saitama, Japan Study Objective: To evaluate the effect of post-operative use of oral contraceptives (OC) in endometrioma recurrence and to identify the variables associated with high discontinuation rates of OC. Design: A prospective cohort study.
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cervical cancer cell lines. The aim of the study was to demonstrate the effect of MIS treatment on endometriosis cell lines through apoptosis and autophagy. Design: Endometriosis cell lines treated with MIS, following the treatments growth inhibition, apoptosis and autophagy was measured. Setting: UTMB Obstetrics and Gynecology Research Laboratories. Intervention: Cultured CRL-7566 endometriosis cell lines from ovarian cyst (ATCC, Manassas, VA) were harvested at 80% confluency and placed in 96-well plates at 2000 cells per well. After 24 hours of incubation, each well was treated with human recombinant MIS (R&D Systems, Minneapolis, MN) at 10 mcg/mL, 5 mcg/mL, or with PBS as a buffer control. MIS and buffer control were added again after 4 days. Measurements and Main Results: MTT cell viability assay was performed on day 7. MIS caused dose-dependent inhibition in growth of endometriosis cell lines. Maximum inhibition of 50% was observed at 10mcg/mL MIS concentration followed by 44% growth inhibition at 5mcg/mL. Apoptosis was assessed by annexin V, by examining cell cycle analysis (sub-G1), and by PARP cleavage by Western blot. Cell lines treated with MIS at 10mcg/mL concentration showed 14.7% annexin positivity, as opposed to control group with 7.8% positivity.To detect and quantify acidic vesicular organelles, we stained cells with acridine orange. Autophagy was determined by fluorescence-activated cell sorting (FACS) analysis. MIStreated endometrial cell lines showed 24% autophagy compared with control group, which showed 60% autophagy. Conclusion: Our in vitro study revealed that MIS treatment induces apoptosis and cellular death in ectopic endometrial cells. We also revealed that MIS treatment inhibits basal autophagy in ectopic endometrial cells. 470 Is Pouch of Douglas (POD) Obliteration a Marker of Bowel Endometriosis? Khong S-Y, Bignardi T, Lam A, Luscombe G. Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia; Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia; Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia; Centre for Advanced Reproductive Endosurgery, Sydney, New South Wales, Australia Study Objective: To assess predictive value of POD obliteration in the diagnosis of bowel endometriosis. Design: Prospective study between October 2004 and September 2008. Setting: University-affiliated tertiary referral centre for endometriosis. Patients: 454 consecutive women who underwent laparoscopic surgery for treatment of pelvic pain and/ or infertility-associated endometriosis. Intervention: Logistic regression analyses were performed to investigate the predictive value of POD obliteration at laparoscopy in regards to bowel endometriosis. Measurements and Main Results: 22.2% (101/454) of our sample population were found to have obliteration of the POD. Of these, 54.5% (55/101) required bowel shaving (67.3%), wedge (7.3%) or full segmental bowel resection (12.7%) or a combination of bowel procedures (12.7%). All had histological confirmation of bowel endometriosis. Of the remaining 46 women, 90.2% had endometriosis confirmed elsewhere in the pelvis. Conclusion: Obliteration Pouch of Douglas is a strong predictor of bowel endometriosis (p\0.001). Surgery in these cases are highly challenging with significant associated risks therefore clinicians may consider referring these patients to a dedicated endometriosis centre with multidisciplinary expertise for further management. 471 Post-Operative Use of Oral Contraceptives for Prevention of Endometrioma Recurrence after Laparoscopic Excision: Efficacy and Compliance Difficulties Kobori H, Watari A, Kumakiri Y, Nagai F, Yamamoto T. Koshigaya Municipal Hospital, Koshigaya, Saitama, Japan Study Objective: To evaluate the effect of post-operative use of oral contraceptives (OC) in endometrioma recurrence and to identify the variables associated with high discontinuation rates of OC. Design: A prospective cohort study.