Long-term conservative management of symptomatic bladder endometriosis: A case series of 17 patients
Long-term conservative management of symptomatic bladder endometriosis: A case series of 17 patients
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有症状的膀胱子宫内膜异位症的长期保守治疗：17 例患者的病例系列
DOI：
10.1016/j.tjog.2022.02.044
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发表时间：
2022
影响因子：
2.1
通讯作者：
Osuga Yutaka
中科院分区：
文献类型：
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作者：
Nagashima Natsuki;Hirata Tetsuya;Arakawa Tomoko;Neriishi Kazuaki;Sun Hui;Harada Miyuki;Hirota Yasushi;Koga Kaori;Wada-Hiraike Osamu;Osuga Yutaka
目的探讨膀胱子宫内膜异位症（BE）长期保守治疗的效果。材料与方法回顾性分析17例BE保守治疗的临床资料。以下因素进行了分析：年龄，病史，病变大小，症状，激素治疗，和后续outcomes.ResultsIn这项研究中，15例接受激素治疗，2没有。口服避孕药（OC），地诺孕素（DNG）和促性腺激素释放激素激动剂（GnRHa）作为第一个方案，分别在7，5和3例患者。在7例患者中，OC给药可有效缓解除2例患者外的所有患者的泌尿系统症状。在接受GnRHa治疗的3例患者中，2例转为OC，然后是DNG，1例患者因不良反应而停止治疗。5例接受DNG治疗的患者均出现症状缓解。DNG、OC和GnRHa给药分别在9/10例患者（90.0%）、5/9例患者（55.6%）和2/3例患者（66.7%）中有效和耐受。特别是，3例患者完成DNG治疗直至绝经。BE病变的大小显着下降后3个月的DNG管理，并保持减少效果，直到48个月after.ConclusionThis研究提出，激素治疗BE是一种有效的选择，对于那些不打算怀孕或接受手术。具体而言，考虑到长期使用的有效性和耐受性，DNG可能适用于拒绝手术的患者。
ObjectivesThis study aimed to evaluate the course of long-term conservative management of bladder endometriosis (BE).Materials and methodsWe retrospectively reviewed 17 cases of BE conservatively managed without surgery in our facility. The following factors were analyzed: age, medical history, lesion size, symptoms, hormonal treatment, and follow-up outcomes.ResultsIn this study, 15 patients received hormonal therapy and 2 did not. Oral contraceptive (OC), dienogest (DNG), and gonadotropin-releasing hormone agonist (GnRHa) were administered as the first regimen in 7, 5, and 3 patients, respectively. Of the 7 patients, OC administration was effective in alleviating urinary symptoms in all but 2 patients. Of 3 patients who received GnRHa, 2 switched to OC and then DNG, and 1 patient discontinued the treatment because of adverse effects. Of 5 patients who received DNG, all experienced symptom relief. DNG, OC, and GnRHa administration were effective and tolerable in 9 of 10 patients (90.0%), in 5 of 9 patients (55.6%), and in 2 of 3 patients (66.7%), respectively. In particular, 3 patients completed DNG treatment until menopause. The size of the BE lesion significantly decreased after 3 months of DNG administration, and the reduction effect was maintained until 48 months thereafter.ConclusionThis study proposed that hormonal therapy for BE is an effective option for those who are not planning to conceive or to undergo surgery. Specifically, DNG may be suitable for patients refusing surgery, considering the effectiveness and tolerance for long-term use.