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Fertility and Sterility Feb 2014To review systematically the literature on uterus-sparing surgical treatment options for adenomyosis. (Review)
Review
OBJECTIVE
To review systematically the literature on uterus-sparing surgical treatment options for adenomyosis.
DESIGN
Systematic literature review.
SETTING
Tertiary academic center.
PATIENT(S)
Women with histologically proven adenomyosis treated with uterus-sparing surgical techniques.
INTERVENTION(S)
Conservative uterine-sparing surgery for adenomyosis classified as (1) complete excision of adenomyosis, (2) cytoreductive surgery or incomplete removal of the lesion, or (3) nonexcisional techniques, with studies selected if women with adenomyosis were treated surgically without performing hysterectomy.
MAIN OUTCOME MEASURE(S)
The cure rate after interventional strategies, the rate of symptom (dysmenorrhea and menorrhagia) control, and pregnancy rate in each group of intervention.
RESULT(S)
A quality assessment tool was used to assess the scientific value of each study. In total, 64 studies dealing with 1,049 patients were identified. After complete excision, the dysmenorrhea reduction, menorrhagia control, and pregnancy rate were 82.0%, 68.8%, and 60.5%, respectively. After partial excision, the dysmenorrhea reduction, menorrhagia control, and pregnancy rate were 81.8%, 50.0%, and 46.9%, respectively.
CONCLUSION(S)
Uterine-sparing operative treatment of adenomyosis and its variants appear to be feasible and efficacious. Well-designed, comparative studies are urgently needed to answer the multiple questions arising from this intriguing intervention.
Topics: Adenomyosis; Female; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Pregnancy; Pregnancy Rate; Treatment Outcome; Uterus
PubMed: 24289992
DOI: 10.1016/j.fertnstert.2013.10.025 -
PloS One 2013Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this... (Review)
Review
BACKGROUND
Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding.
OBJECTIVES
We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy.
SEARCH STRATEGY
A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers.
RESULTS
Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy). Six patients were initially treated by silver nitrate application without success.
CONCLUSIONS
This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment.
Topics: Abdominal Pain; Dyspareunia; Fallopian Tube Diseases; Fallopian Tubes; Female; Humans; Hysterectomy; Postoperative Complications; Prolapse
PubMed: 24116117
DOI: 10.1371/journal.pone.0076543