Endometrioma tedavisinde alkol ile skleroterapi sonuçlarının değerlendirilmesi
Date
2021Author
Azizova, Aynur
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Purpose: This study aims to investigate the efficacy and safety of ethanol sclerotherapy in endometrioma treatment.
Materials and Methods: From January 1st, 2015 to March 15th, 2021, the preprocedural, procedural, and postprocedural follow-up findings of 55 patients (mean age: 30 years, range: 15-40 years) whose endometrioma treated with the transabdominal or transvaginal needle- or catheter-directed ethanol sclerotherapy at Hacettepe University Department of Radiology, Non-vascular Intervention Unit were evaluated retrospectively. The study included 51 patients (68 cysts) whose postprocedural follow-up findings were available. Technical and clinical success rates, reduction rates of maximal cyst size, cyst volume, pain complaints, serum CA-125 levels and serum AMH levels, complications, hospital stays, follow-up duration, and recurrence rates were evaluated. The clinical success rates of 2 different treatment routes and 2 different treatment techniques were compared. Furthermore, the treatment results of the patients with main complaints of pain (n=40) and infertility (n=11) were evaluated separately. In addition, the effects of the presence of deep infiltrating endometriosis, localization of treated cysts in one or both ovaries, and the presence of untreated cysts in the same patient group due to cyst size were evaluated on the treatment outcomes.
Results: The technical success rate was 100%. There was no minor complication. The only major complication (2%) was cavity infection observed in 1 patient. The mean length of hospital stay was 0.7 (SD, ± 0.4) days. The mean follow-up duration was 14.5 (SD, ±11.0; minimum 1.0 month; maximum 55.0 months) months. One patient with two cyst (3%) underwent a second session of ethanol sclerotherapy due to recurrence, and the clinical success rate was found to be 100%. There was a significant decrease in pain complaints, serum CA-125 levels, maximal cyst sizes, and cyst volumes in all treated patients (p<0.05). There was an increase in mean serum AMH levels, a reliable serum marker of ovarian reserve, compared to the pretreatment levels in all treated patients and statistically, there was no significant decrease in serum AMH levels (p>0.05). The pregnancy rate was 54% in patients treated for infertility, and 100% in patients treated for pain without infertility. The study revealed that pretreatment serum AMH levels do not affect the treatment results (p>0.05). Therefore, it was concluded that there is no lower limit for serum AMH level for patient selection for ethanol sclerotherapy. The recurrence rate was 6% (n=1) in the needle-directed ethanol sclerotherapy. There was no recurrence in the catheter-directed ethanol sclerotherapy. There was more significant reduction in cysts treated with the catheter technique, the transabdominal route and the transabdominal catheter technique, and it was thought that it might be related not only to the treatment technique applied, but also to the pretreatment cyst size. The study showed that the large pretreatment cyst volumes are associated with more significant decrease in the maximal cyst size and volume (p<0.05). Also, regardless of the treated cyst size, the ovarian reserve was preserved (p>0.05). The study revealed that the rate of decrease in the maximal cyts size and volume after treatment was less in deep infiltrative endometriosis group (p<0.05). Also, it was observed that the presence of deep infiltrative endometriosis did not affect the degree of decrease in pain (p>0.05). In addition, the presence of deep infiltrative endometriosis was not associated with a decrease in ovarian reserve after alcohol sclerotherapy (p>0.05). It was determined that the presence of untreated cyst could have a negative effect on ovarian reserve (p<0.05). The study showed that the decrease in cyst volumes was more pronounced (p<0.05) in the patient group whose one ovarian cysts were treated compared to the group of patients whose both ovarian cysts were treated. It was shown that sclerotherapy of both ovarian endometriomas do not cause a decrease in ovarian reserve compared to the sclerotherapy of one ovarian endometrioma (p>0.05).
Conclusion: According to the results of our study, ethanol sclerotherapy is an effective and successful treatment method that preserves ovarian reserve with a high clinical success rate, low complication rate, low recurrence rate and short hospital stay for endometrioma treatment.
Keywords: Endometriosis; Ovarian endometrioma; Ethanol sclerotherapy; Infertility; Ovarian reserve