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Deep endometriosis: definition, pathogenesis, and clinical management
Paolo Vercellini1, Giada Frontino, Giuliana Pietropaolo
1Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy.
Summary
Deep endometriosis involves infiltrative lesions affecting vital organs. While medical treatments offer temporary relief, surgery remains the definitive solution for severe cases, emphasizing patient counseling for informed treatment decisions.
Area of Science:
- Gynecology
- Reproductive Medicine
- Surgical Pathology
Background:
- Deep endometriosis is characterized by infiltrative lesions impacting critical pelvic structures like the bowel, bladder, and ureters.
- Current understanding suggests a unified pathogenesis for deep infiltrating endometriosis, originating from intraperitoneal seeding of endometrial cells.
Purpose of the Study:
- To review the pathogenesis, classification, and management of deep endometriosis.
- To highlight the role of intraperitoneal seeding in the development of deep endometriotic lesions.
Main Methods:
- Review of existing evidence on the pathogenesis of deep endometriosis.
- Analysis of anatomical, surgical, and pathological findings related to deep endometriosis.
- Evaluation of current medical and surgical treatment strategies.
Main Results:
- Deep endometriosis likely originates from intraperitoneal seeding of regurgitated endometrial cells, leading to inflammation and adhesion.
- Lateral asymmetry in ureteral endometriosis supports the menstrual reflux theory.
- Medical treatments, particularly progestins, provide temporary pain relief, while surgery is the definitive treatment for severe disease.
Conclusions:
- Deep endometriosis, including vesical and rectovaginal forms, shares a common intraperitoneal origin.
- While classification schemes exist, further data are needed to establish their validity.
- Effective patient counseling is crucial for managing expectations and enhancing collaboration in treatment decisions.