deep endometriosis
2 articles
Deep endometriosis – impact on infertility, endometriosis fertility index, and reproductive prognosis (comparative study)
Introduction
Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis, contributes to pelvic pain syndrome, extragenital symptoms, fertility problems, and diminished reproductive prognosis for affected individuals. It is recommended to use the Endometriosis Fertility Index (EFI) to assess reproductive prognosis and conduct clinical research to compare reproductive prognosis in different forms of endometriosis.
Objective
Comparison of the impact of the DIE and others forms of endometriosis on EFI, patients' fertility and on reproductive prognosis to understand the management approach.
Materials and methods
A cohort study included 190 reproductive-age women, divided according to the #Enzian classification: the main group - 85 patients with DIE, the control group - 105 women with other forms of endometriosis. The EFI was utilized for reproductive prognosis. Pain was evaluated with Visual Analog Scale (VAS). Statistical analyses were performed using SPSS, with calculation of the Mann-Whitney U and Pearson's chi-square test (χ²).
Results
In main group, the frequency of infertility was 83.5% compared to the control group's 71.4% (p > 0.05). The EFI in main group was 7.18±0.25 points vs the control group's 7.13±0.28 points (p = 0.852). Patients in the main group suffered from intense pelvic pain (>7 points by the VAS, p < 0.01), including severe dyspareunia (7.85±0.33 points vs 2.18±0.46 points in control group, p < 0.01).
Conclusions
Our results suggest that infertility in women with DIE may be more often associated with sexual abstinence due to significant dyspareunia rather than organic impairments. Thus, EFI in patients with DIE does not reflect all aspects of infertility and has reservations, and consideration of both physical symptoms and sexual health is crucial in managing DIE to optimize fertility outcomes. These findings open the way to the feasibility of surgical treatment of DIE to improve sexual quality of life, which will reduce the need for IVF and increase the chances of spontaneous pregnancy in patients, but this conclusion requires further investigation in randomized clinical trials.
Deep endometriosis – diagnosis and impact on quality of life
Introduction
Deep infiltrating endometriosis (DIE) is considered the most painful form of endometriosis, responsible for reducing the women's quality of life (QoL). Its management presents difficulties in medicine. The #Enzian classification reflects locations of DIE and simplifies its medical management. International guidelines recommend studies of QoL in women with endometriosis.
Objective
To investigate the symptoms of DIE and determine its impact on QoL to optimize its diagnostics.
Materials and methods
A cohort study was conducted over 2 years at the Gheorghe Paladi Municipal Clinical Hospital, including 190 patients with endometriosis, who were divided into groups: main group - 85 patients with DIE, control group - 105 other endometriosis forms. To objectify the pain, Visual Analog Scale and Biberoglu and Behrman (B&B) were used. Endometriosis was staged with the #Enzian classification. For the analysis of QoL, three standardized questionnaires were used. Data were recorded in Excel and statistically calculated with the SPSS program.
Results
Pelvic pain syndrome according to the Visual Analog Scale and B&B scales in the main group was 3 times more pronounced than in the control group (p < 0.01). Lesions of DIE according to the #Enzian statistically correlated with chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, dyschezia >7 points (VAS), catamenial rectal tenesmus, defecation disorders, menometrorrhagia, hematuria, bladder tenesmus, hydronephrosis with ureteral stenting during pregnancy, catamenial cough and hemoptysis, chest pain and spontaneous pneumothorax, hemorrhagic scar, hiccups, and the frenicus symptom (p < 0.05). According to the questionnaires of QoL, DIE significantly influences life determinants by 44.27%, compared to the control group at 3.64% (p < 0.01), allowing realization of life determinants in a maximum of 58.54% vs. the control group’s 92.18% (p < 0.01). Additionally, psychological well-being in patients with DIE is lower than that in the control group (44.29% vs. 81.38%, p < 0.01).
Conclusions
High-intensity pain syndrome and extragenital symptoms correlated with compartments of #Enzian will assist in the preoperative multidisciplinary diagnosis of DIE. The high influence on life determinants, the low realization of life potential, and the low psychological well-being confirm the significant impact of DIE on QoL, classifying it as a disability.