A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis
Adenomyosis is commonly treated by total hysterectomy. Adenomyomectomy is considered for women of reproductive age who wish to preserve their fertility. However, a high recurrence rate following adenomyomectomy has been reported because complete removal of the lesion is difficult, and uterine ruptur...
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doaj-4b5962854a0b494cb6a7be7c65268ec72021-09-26T00:04:04ZengMDPI AGEndocrines2673-396X2021-09-0123234835510.3390/endocrines2030032A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II AdenomyosisYoshiaki Ota0Kuniaki Ota1Toshifumi Takahashi2Yumiko Morimoto3So-Ichiro Suzuki4Rikiya Sano5Ikuko Ota6Takuya Moriya7Mitsuru Shiota8Department of Gynecological Oncology, Kawasaki Medical School, Kurashiki 701-0192, JapanFukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, JapanFukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, JapanDepartment of Gynecological Oncology, Kawasaki Medical School, Kurashiki 701-0192, JapanDepartment of Gynecological Oncology, Kawasaki Medical School, Kurashiki 701-0192, JapanDepartment of Gynecological Oncology, Kawasaki Medical School, Kurashiki 701-0192, JapanDepartment of Gynecology, Kurashiki Heisei Hospital, Kurashiki 710-0826, JapanDepartment of Pathology, Kawasaki Medical School, Kurashiki 701-0192, JapanDepartment of Gynecological Oncology, Kawasaki Medical School, Kurashiki 701-0192, JapanAdenomyosis is commonly treated by total hysterectomy. Adenomyomectomy is considered for women of reproductive age who wish to preserve their fertility. However, a high recurrence rate following adenomyomectomy has been reported because complete removal of the lesion is difficult, and uterine rupture during pregnancy remains a complication. We previously reported that laparoscopic adenomyomectomy using a cold knife prevented thermal damage to the myometrium and elastography to avoid residual lesions. Here, we report the case of a patient who underwent complete resection of a subtype II adenomyosis and resection of deep endometriosis (DE) with the closure of the pouch of Douglas. The patient was 31 years old, had severe dysmenorrhea, and had left ureteral stenosis and subtype II adenomyosis associated with the closure of the pouch of Douglas by the DE. After resection of the DE posterior wall adenomyosis, residual lesions were confirmed by laparoscopic real-time elastography. Eight weeks after surgery, postoperative transvaginal ultrasound showed that the myometrium had shrunk from 28 to 22.7 mm, and the hydronephrosis had disappeared, although a stent remained necessary. In this study, we report the complete resection of subtype II adenomyosis and DE, combined with elastography to visualize the lesions during resection.https://www.mdpi.com/2673-396X/2/3/32adenomyosisendometriosislaparoscopicelastography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yoshiaki Ota Kuniaki Ota Toshifumi Takahashi Yumiko Morimoto So-Ichiro Suzuki Rikiya Sano Ikuko Ota Takuya Moriya Mitsuru Shiota |
spellingShingle |
Yoshiaki Ota Kuniaki Ota Toshifumi Takahashi Yumiko Morimoto So-Ichiro Suzuki Rikiya Sano Ikuko Ota Takuya Moriya Mitsuru Shiota A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis Endocrines adenomyosis endometriosis laparoscopic elastography |
author_facet |
Yoshiaki Ota Kuniaki Ota Toshifumi Takahashi Yumiko Morimoto So-Ichiro Suzuki Rikiya Sano Ikuko Ota Takuya Moriya Mitsuru Shiota |
author_sort |
Yoshiaki Ota |
title |
A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis |
title_short |
A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis |
title_full |
A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis |
title_fullStr |
A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis |
title_full_unstemmed |
A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis |
title_sort |
case of elastography-assisted laparoscopic fertility preservation for severe deep endometriosis causing ureteral stenosis and subtype ii adenomyosis |
publisher |
MDPI AG |
series |
Endocrines |
issn |
2673-396X |
publishDate |
2021-09-01 |
description |
Adenomyosis is commonly treated by total hysterectomy. Adenomyomectomy is considered for women of reproductive age who wish to preserve their fertility. However, a high recurrence rate following adenomyomectomy has been reported because complete removal of the lesion is difficult, and uterine rupture during pregnancy remains a complication. We previously reported that laparoscopic adenomyomectomy using a cold knife prevented thermal damage to the myometrium and elastography to avoid residual lesions. Here, we report the case of a patient who underwent complete resection of a subtype II adenomyosis and resection of deep endometriosis (DE) with the closure of the pouch of Douglas. The patient was 31 years old, had severe dysmenorrhea, and had left ureteral stenosis and subtype II adenomyosis associated with the closure of the pouch of Douglas by the DE. After resection of the DE posterior wall adenomyosis, residual lesions were confirmed by laparoscopic real-time elastography. Eight weeks after surgery, postoperative transvaginal ultrasound showed that the myometrium had shrunk from 28 to 22.7 mm, and the hydronephrosis had disappeared, although a stent remained necessary. In this study, we report the complete resection of subtype II adenomyosis and DE, combined with elastography to visualize the lesions during resection. |
topic |
adenomyosis endometriosis laparoscopic elastography |
url |
https://www.mdpi.com/2673-396X/2/3/32 |
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