Lateral parametrial endometriosis (LPE) is a more severe manifestation of endometriosis and requires more aggressive surgery, according to researchers in Italy.
Their study, “Parametrial Endometriosis: the Occult Condition that Makes the Hard Harder,” was published in The Journal of Minimally Invasive Gynecology.
Deep infiltrating endometriosis (DIE) represents the most severe form of endometriosis and affects 20% of patients with the condition.
DIE is defined as the presence of endometrial tissue infiltration outside of the endometrium into organs that are near the uterus, including the bowel and the urinary bladder. DIE is the most invasive form of endometriosis as it is found deep within the tissue or organ.
DIE can sometimes involve the lateral parametrium, which is a band of fibrous tissue that separates the supravaginal (above the vagina) portion of the cervix from the bladder.
Even if physicians suspect that a patient has lateral parametrial endometriosis (LPE) during a clinical examination, the gold standard for diagnosis is to conduct a surgical dissection.
Despite the enormous impact of LPE, only a few studies have assessed its diagnosis, prevalence, and clinical features.
Researchers from S. Orsola Hospital, University of
Bologna in Italy, set out to estimate the intraoperative (during surgery) prevalence of LPE in patients affected by DIE and to analyze the clinical and surgical data associated with LPE.
Researchers investigated 1,360 women who were admitted for surgery of DIE between 2007 and 2017. Women were then divided into two groups according to the presence (231 patients) or absence (1,129 patients) of LPE.
Results indicated that the intraoperative prevalence of lateral parametrial endometriosis was 17%.
When looking at factors before the operation, women with LPE complained of having more severe dysmenorrhea (painful periods), more frequent voiding symptoms (a condition where there is poor coordination between the bladder muscle and the urethra), and more constipation.
During the surgery, researchers found that the presence of lateral parametrial endometriosis was associated with several factors, including the involvement of various vaginal areas.
During the operation, LPE patients tended to have a lump with a larger diameter.
The operation time and hospital stay were also longer for patients with LPE.
And, the lateral parametrial endometriosis group needed self-catheterization (a process which allows the patient’s urine to drain freely from the bladder for collection) more often than the control group at the time of discharge and at the one-month follow-up evaluation.
“LPE is an occult and not so rare condition and reflects a more severe manifestation of the disease, requiring more aggressive surgery,” the researchers wrote.
“Patients must be evaluated thoroughly and counselled properly during the preoperative examination, taking into account the significant morbidity, particularly regarding pelvic organ dysfunctions,” they added.