Unfortunately
I’ve been a bit behind this month, but I always keep my eye on what going on in
the world of endo research.
So with that
in mind let’s have a look at what’s been going on
Firstly, a study into surgical
treatment for endometriosis of the bladder. This form of the disease isn’t
particularly common, but it does add another layer of misery to the sufferer so
knowing the optimal treatment is important. This study took sixty nine patients
with bladder endometriosis and recorded what surgical procedures they had and
how this affected their symptoms afterward. After follow up period of between 4
and 92 months, 92.7% of the women either had no symptoms, or a reduction in
symptoms. What this study highlighted was the need for surgeons with specialist
training in different types of endo (i.e. bladder, bowel etc) as they may
require a different surgical approach.
Speaking of
bladder and bowel surgery, up next is a report on the use of
robotic assisted surgery for the treatment of just those conditions. This study
included 19 cases of bowel surgery and 5 cases of bladder surgery, all of which
occurred without complications. Now, robot-assisted surgery is a hot topic at
the moment because it is a new and growing technique. But we are also stuck in
a catch-22 situation with robotic surgery. You see, people are reluctant to
support robotic surgery until there are more studies into its effectiveness,
but you can’t have more studies until you support wider use of robotic surgery.
Either way it looks like robotic surgery is here to stay and it is a safe and
effective tool with a skilled surgeon at the helm.
Speaking of
robot-assisted surgery, there are many different types of surgical procedure
the robot can be utilised for in the treatment of endometriosis. In severe
cases of the disease, doctors may opt for hysterectomy and our next study
examines the safety and effectiveness of using the robot for such a procedure. In
summary this study looked at 43 cases of women with severe endo (19 with stage
III and 24 with stage IV). The results of which were - operating times averaged at 145 minutes (with
a variation of 67-325 mins); 41 out of 43 women only had a 1day hospital stay,
with one woman needing to stay for 5days due to needing a laparotomy and one
woman staying 3days because of a bowel obstruction that cleared. There were no
reported complications during surgery though after surgery one woman had to be
readmitted with a vaginal cuff abscess which was treated with antibiotics and
drained. The authors of this study make some good points about the pros and
cons of robotic surgery, namely – “The
robotic platform improves the depth of perception and facilitates the resection
of deep infiltrating lesions. In addition, the robotic system improves
dexterity, filters the surgeon’s tremor, and improves intuitive movements”;
however they also say “Robotic surgery
has several disadvantages compared with traditional laparotomy. These include
increased cost; the lack of tactile feedback to the surgeon [i.e the ‘feel’
of the toughness or resistance of tissues];
the presence of bulky robotic arms, as well as long and thick cords; the
inability to move the surgical table once the robot arms are attached; and a
limited range of motion with respect to operating in different quadrants in the
same case”.
Sticking
with a surgical theme is a study
from the US looking at the effectiveness of surgical excision of endometriosis
across five different medical centre’s. All the women included in this study
were suffering endometriosis associated pain, of which 90 had operative
information. Once these women were operated on, 65 were confirmed to have
endometriosis and 25 had no confirmation of endo. Interestingly, of all the
patients who had endometriosis confirmed at these centres, 84.6% had previously
been given hormonal therapy or ablation (burning away of endo) surgery,
indicating that these treatments are not very effective at reducing endo pain
symptoms. After their surgeries, all of
the women in the different centres noticed a significant reduction in all but bowel
symptoms (bowel symptoms were reduced though, but the amount of reduction
wasn’t considered statistically significant). Interestingly the authors of this
study found there was no significant difference in the pain and quality of life
scores between women who were given hormonal therapy after excision surgery and
those who weren’t. However, the post-operative information was collected 6
months after surgery, so long term effectiveness couldn’t be gauged. In any
case this study shows that excision of endometriosis is still the preferred
method of treatment for the disease where possible.
It is
rapidly becoming apparent that endometriosis is a disease that begins to
present itself in adolescence. This is extremely important to know because it
means general practitioners need to be able to spot the signs of endometriosis
in young girls and make sure they get treatment as soon as possible. But what
are the major signs of endo? A new study looking at
diagnosis of endo in adolescent girls found that 75% of girls with chronic
pelvic pain (which is any pain in the pelvic area that lasts more than six
months) that did not respond to medical treatment and 70% of girls with dysmenorrhoea
(excessively painful/heavy periods) were later diagnosed with endometriosis.
All doctors need to be aware of these ‘red flags’ and act on them quickly.
Next up is
copper, which is great for electrical wiring and making cheap jewellery, but
also may be important for endometriosis. Our bodies need miniscule amount of
copper to function properly, but as with so very many things in this world,
there is fine balance to be kept. In your body copper can float around by
itself, but is also carried around by a protein called ceruplasmin and this latest study looked at
the levels of both of these in the blood of women with advanced stage
endometriosis compared to disease free women. What they found was that levels
of copper and ceruplasmin were much higher in the blood of women with endo, but
what does this mean? That’s a tricky question to answer because we’re still not
sure what role copper might play in endo. Excess levels of copper are known to
be a marker for oxidative stress and oxidative stress certainly seems to be elevated in women with
endo. Oxidative stress, as the name suggests, is not something you want
happening to excess in your body; prolonged exposure to oxidative stress can
make you run down and generally feel like crap, in addition localised oxidative
stress can actually promote the survival of endometriosis. Further study is
needed to find out if copper is a cause or effect of oxidative stress, but as
an interesting aside, elevated levels of copper in the blood could possibly be
used as an indicator of advanced stage endometriosis.
Finally is a
study from Denmark
about the risk of endometriosis and fertility problems in the daughters of
women with the disease. This was quite a large study, including information
from 12,389 women with endometriosis and 52,371 without. Overall daughters of
women with endometriosis were just over two times more likely to be diagnosed
with endo. However, daughters of women with endo had no difference in the rate
of deliveries, risk of miscarriage and ectopic pregnancy compared to the
daughters of women without endo.
