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Deep Pelvic Endometriosis


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Table of Contents

1 Introduction 1.1 Definition, Prevalence, and Epidemiology 1.2 Pathogenesis 1.2.1 Retrograde Menstruation. 1.2.2 Altered Immunity. 1.2.3 Genetic Factors. 1.2.4 Gross and Microscopic Pathology. 1.2.5 Link to Cancer1.3 Deep Endometriosis 1.4 Classification 2 Diagnosis 2.1 Clinical Features 2.2 Symptoms 2.3 Physical Findings 2.4 Serum Markers 2.5 Laparoscopy2.6 Instrumental Diagnosis 2.6.1 Abdominal Ultrasonography. 2.6.2 Transvaginal Sonography. 2.6.3 Rectal Water-contrast Transvaginal Sonography. 2.6.4 Sonovaginography. 2.6.5 "Tenderness-guided" Ultrasonography. 2.6.6 Three-dimensional Ultrasonography. 2.6.7 Endoscopic Transrectal Ultrasonography. 2.6.8 Magnetic Resonance Imaging. 2.6.9 Colonoscopy. 2.6.10 Double-contrast Barium Enema. 2.6.11 Computerized Tomography. 2.6.12 Cystoscopy. 2.6.13 Intravenous Pyelography. 2.6.14 Ureteroscopy 2.7 Conclusion 3 Treatment3.1 Medical Therapy 3.1.1 Combined Treatment Approaches (Pharmacotherapy and Pain Therapy). 3.1.2 Experimental Treatment Approaches 3.2 Surgery 3.2.1 Laparoscopic Uterosacral Nerve Ablation. 3.2.2 Presacral Neurectomy. 3.2.3 Deep Pelvic Infiltration of the Rectovaginal Septum Without Intestinal Involvement. Surgical Technique. 3.2.4 Deep Infiltrating Endometriosis With Rectal or Rectosigmoid Involvement. Surgical Technique: Laparoscopic Bowel Resection. 3.2.5 Urinary Tract Endometriosis. Bladder Endometriosis. Ureteral Endometriosis. Kidney Endometriosis. Urethral Endometriosis. 3.2.6 Repetitive Conservative Surgery. 3.2.7 Definitive Surgery4 The Experience of Living with Endometriosis 4.1 Introduction 4.2 Diagnosis of Endometriosis 4.2.1 Delay in Diagnosis. 4.2.2 Impact of a Diagnosis of Endometriosis. 4.2.3 Pain4.3 Sexuality 4.3.1 Dyspareunia 4.3.2 Fertility 4.4 Uncertainty 4.5 Impact on Social Life and Relationships 4.6 Interactions with Health Professionals 4.7 Treatments4.8 Summary

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