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Endometriosis - Your Opinion Wanted!
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Question 1. Bowel Preps
Preoperative preparation of the bowel with an oral purgative such as magnesium citrate followed by antibiotics and cleansing enemas Endometriosis of the rectum, recto-vaginal septum appendix or sigmoid colon are frequently seen and may result in entry into the bowel lumen. | |||
| What is your practice regarding bowel preparation? | Your Vote | Vote Tally | % of Total |
| 1. the majority of patients undergoing diagnostic laparoscopy | 35 | 32.11% | |
| 2. restricted to patients where endometriosis is suspected | 17 | 15.60% | |
| 3. only when bowel surgery is anticipated | 56 | 51.38% | |
| 4. rarely | 1 | 0.92% | |
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Question 2. Excision vs Vaporization
It is not unusual for patients with endometriosis and pelvic pain to present with a history of repeated surgical procedures and courses of hormonal therapy. It has been suggested that surgical excision of all visible disease may provide better relief of pain. | |||
| Agree or disagree with the following statements | Your Vote | AGREE Tally | DISAGREE Tally |
| 1. Laser vaporization of endometriosis and excisional therapy are equally effective. | 34 (37.78%) | 56 (62.22%) | |
| 2. Laser vaporization of the this disease would be more likely to result in recurrence than excisional therapy. | 41 (46.07%) | 48 (53.93%) | |
| 3. With involvement of the uterosacral ligament and culdesac, a six month course of GnRH-a therapy can provide prolonged relief equal to surgery. | 27 (31.40%) | 59 (68.60%) | |
| 4. Aggressive surgical excision will usually cure endometriosis. | 27 (31.76%) | 58 (68.24%) | |
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Question 3. Endometriosis & Infertility
Minimal endometriosis is frequently noted at the time of diagnostic laparoscopy performed during an infertility evaluation. Assuming a 38 year old female with 3 years of unexplained infertility, normal ovulatory cycles, negative cultures, normal HSG, semen analysis and hormonal studies, and laparoscopy reveals patent normal appearing fallopian tubes and ovaries with minimal peritoneal and cul-de-sac retroperitoneal endometriosis. | |||
| Treatments you would consider | Your Vote | Vote Tally | % of Total |
| 1. Laser vaporization of visible lesions | 50 | 59.52% | |
| 2. Surgical excision of all visible lesions | 45 | 53.57% | |
| Adjunctive GnRH-a therapy for: | |||
| 3a. Adjunctive GnRH- No agonist therapy | 25 | 29.76% | |
| 3b. Adjunctive GnRH- 1-3 months | 16 | 19.05% | |
| 3c. Adjunctive GnRH- 6 months of therapy | 17 | 20.24% | |
| 3d. Adjunctive GnRH- only treat patients with residual disease | 8 | 9.52% | |
| After the treatment chosen in 1-3 above, the most appropriate therapy for this couple would be: | |||
| 4a. Up to 6 months of urinary LH timed intercourse prior to further medical therapy | 35 | 41.67% | |
| 4b. Clomiphene and intrauterine insemination (IUI).for 3-6 cycles | 17 | 20.24% | |
| 4c. Gonadotropin therapy and IUI | 10 | 11.90% | |
| 4d. GnRH-a, gonadotropin stimulation and IUI | 4 | 4.76% | |
| 4e. IVF | 11 | 13.10% | |
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Question 4. Endometriosis and the Immune System
Studies looking at the role of immune system and endometriosis have provided conflicting information. It has been suggested that endometrial cells recovered from the peritoneal fluid in women with endometriosis are less immunogenic and not as easily cleared by peritoneal macrophages. Other studies have shown that peritoneal macrophages from women with endometriosis are less competent when it comes to clearing endometrial cells. Peritoneal NK-cell numbers are reduced as the severity of endometriosis increases. Women with endometriosis are more likely to demonstrate autoantibodies to phopholipids. | ||||
| Agree or disagree with the following statements: | Your Vote | AGREE | DISAGREE | Don't Know |
| 1. Endometriosis is due to a disorder of the immune system. | 36 (46.15%) | 10 (12.82%) | 32 (41.03%) | |
| 2. The immune system abnormalities are caused by endometriosis rather than a cause of this disorder. | 15 (19.23%) | 27 (34.62%) | 36 (46.15%) | |
| 3. More studies are necessary to explore the relationship between the immune system and endometriosis. | 73 (93.59%) | 1 (1.28%) | 4 (5.13%) | |
Endometriosis Questions Bulletin Board:
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