International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
Evaluation of rectal endometriosis treatment with high-intensity focused ultrasound versus surgery: A clinical retrospective multicenter trial.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Dubernard Gil, Devantay Chloé, Philip Charles-André, Warembourg Sophie, Nguyen-Ba Emilie, Dennis Thomas, Merlot Benjamin, Roman Horace
Аннотация
OBJECTIVE: We conducted a comparative retrospective bicentric study of rectal endometriosis treatment with high-intensity focused ultrasound (HIFU) and surgery in terms of symptoms and treatment-related morbidity at 6 months.
METHODS: All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF-36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien-Dindo classification.
RESULTS: A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien-Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% (P = 0.002) and 0% versus 10% (P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), diarrhea (P < 0.001), tenesmus/spasms (P < 0.001), pain on defecation (P < 0.001), and urinary urgency (P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.017), diarrhea (P < 0.002), tenesmus/spasms (P < 0.001), and pain on defecation (P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months.
CONCLUSION: In selected patients with only one rectal location, HIFU treatment enables a similar symptom-related and quality-of-life outcome with a significant reduction in the risk of postoperative complications.
METHODS: All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF-36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien-Dindo classification.
RESULTS: A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien-Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% (P = 0.002) and 0% versus 10% (P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), diarrhea (P < 0.001), tenesmus/spasms (P < 0.001), pain on defecation (P < 0.001), and urinary urgency (P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea (P < 0.017), diarrhea (P < 0.002), tenesmus/spasms (P < 0.001), and pain on defecation (P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months.
CONCLUSION: In selected patients with only one rectal location, HIFU treatment enables a similar symptom-related and quality-of-life outcome with a significant reduction in the risk of postoperative complications.