Modern Approaches to Endometriosis PDF
Preview Modern Approaches to Endometriosis
Modern Approaches to Endometriosis Modern Approaches to Endometriosis Edited by Eric J. Thomas, MD Professor, Department of Human Reproduction and Obstetries, University of Southampton, Southampton, UK and John A. Rock, MD Professor, Department of Obstetrics and Gynecology, Johns Hopkins University Hospital, Baltimore, Maryland, USA • SPRINGER SCIENCE+BUSINESS MEDIA. B.V. British Library Cataloguing in Publication Data Modem approaches to endometriosis. 1. Women. Endometriosis I. Thomas, Erie ]. 11. Rock, lohn A. 618.14 ISBN 978-94-010-5719-6 Library of Congress Cataloguing in Publication Data Modem approaches to endometriosis/edited by Erle]. Thomas and lohn A. Rock. p. cm. Includes bibliographical referenees and index. ISBN 978-94-010-5719-6 ISBN 978-94-011-3864-2 (eBook) DOI 10.1007/978-94-011-3864-2 1. Endometriosis. I. Thomas. Erle ]. 11. Rock. lohn A. RG483.E53M63 1991 90-22965 618.1-dc20 CIP Copyright © 1991 by Springer Science+Business Media Donlrecht Originally published by Kluwer Academic Publishers in 2003 Softcover reprint of the hardcover 1s t edition 2003 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, eleetronie, mechanieal, photoeopying, reeording or otherwise, without prior permission from the publishers, Springer Science+Business Media, B.Y. Contents List of contributors vii Preface ix Section A: SCIENTIFIC ASPECTS OF ENDOMETRIOSIS 1 The pathogenesis and aetiology of endometriosis A. F. Haney 3 2 The endometriotic implant 1. A. Brosens 21 3 Steroid receptors in endometriosis A. Bergqvist 33 4 The endometrium and endometriosis S. K. Smith 57 5 The peritoneal environment in endometriosis B. S. Hurst and]. A. Rock 79 6 The immune system in endometriosis W. P. Dmowski, D. Braun and H. Gebel 97 7 Endometriosis and infertility E. ]. Thomas 113 Section B: CLINICAL ASPECTS OF ENDOMETRIOSIS 8 The classification of endometriosis: a comprehensive review T. R. Groff 131 9 Extrapelvic endometriosis S. M. Markham 151 10 Macro- and microsurgical treatment of endometriosis ]. M. Wheeler 183 v MODERN APPROACHES TO ENDOMETRIOSIS 11 Laser laparoscopy in the treatment of endometriosis C. ]. G. Sutton 199 12 Gestogens and anti-gestogens as treatment of endometriosis E. ]. Thomas and L. Mettler 221 13 The use of danazol as a treatment of endometriosis R. L. Barbieri 239 14 GnRH analogues in the treatment of endometriosis - rationale and efficacy R. W. Shaw 257 15 The role of definitive surgery and hormone replacement therapy in the treatment of endometriosis A. F. Henderson and]. W. W. Studd 275 16 The future E. ]. Thomas and ]. A. Rock 291 Index 295 vi List of contributors R. L. Barbieri H. Gebel Department of Obstetrics and Departments of Immunology/Microbiology Gynecology and General Surgery Health Sciences Center Rush Medical College SUNY at Stony Brook 1725 W. Harrison Stony Brook Chicago, IL 60614 New York 11794-8091 USA USA T. R. Groff 2455 N.E. Loop 410, Suite 242 A. Bergqvist San Antonio, TX 78217 Department of Obstetrics and USA Gynecology University of Lund A. F. Haney Malmo General Hospital Duke University Medical Center S-214 01 Malmo PO Box 2971 Sweden Durham, NC 27710 USA D. Braun Departments of Internal Medicine and A. F. Henderson Immunology/Microbiology King's College Hospital Rush Medical College Denmark Hill 1725 W. Harrison London Chicago, IL 60614 UK USA B. S. Hurst Department of Obstetrics and I. A. Brosens Gynecology Division of Obstetrics and Gynaecology Division of Reproductive Endocrinology Faculty of Medicine The Johns Hopkins Hospital Catholic University of Leuven Baltimore, MD 21205 B-3000 Leuven USA Belgium S. M. Markham Division of Reproductive Endocrinology W. P. Dmowski Department of Obstetrics and Department of Obstetrics and Gynecology Gynecology Georgetown University School of Rush Medical College and Institute for the Medicine Study and Treatment of Endometriosis 3800 Reservoir Road NW Chicago, IL 60614 Washington DC 20007 USA USA vii MODERN APPROACHES TO ENDOMETRIOSIS L. Mettler J. W. W. Studd University Frauenklinik u. Consultant Gynaecologist Michaelsis 316 120 Harley Street Hebammenlehranstalt London WIN lAG 2300 Kiel UK Federal Republic of Germany c. J. G. Sutton J. A. Rock Consultant Gynaecologist Department of Obstetrics and Department of Obstetrics and Gynecology Gynaecology Division of Reproductive Endocrinology Royal Surrey County Hospital The Johns Hopkins Hospital Guildford, Surrey Baltimore, MD 21205 UK USA E. J. Thomas R. W. Shaw Department of Human Reproduction and Academic Department of Obstetrics and Obstetrics Gynaecology Princess Anne Hospital Royal Free Hospital School of Medicine Coxford Road Pond Street Southampton London NW3 2QG S094HA UK UK S. K. Smith J. M. Wheeler Department of Obstetrics and Department of Obstetrics and Gynaecology Gynecology University of Cambridge Baylor College of Medicine Rosie Maternity Hospital 6550 Fannin, #801 Cambridge CB2 2SW Houston, Texas UK USA viii Preface Endometriosis provides a unique clinical and scientific challenge. It is being diagnosed with increasing frequency and yet we are unsure of the significance of this in many patients. Its appearance varies from a tiny focus of disease to a potently destructive phenomenon. Weare still unsure of the relative value of medical or surgical treatment. The pathogenesis and control of the cellular function of the disease proVide many scientific problems. The presence of a comparative normal epithelium, namely endometrium, provides a unique research opportunity. It is probable that only through basic science research will we be able to solve the clinical dilemmas that endometriosis presents. We felt that it was important to create a book that explored the important scientific and clinical problems. We therefore invited acknowledged experts from both Europe and the United States of America to review their fields. The purpose of these reviews is not only to provide a resource for clinicians and scientists but also to stimulate thought and new ideas for research and treatment. To fulfil that aim we have asked that the authors be more speculative than normal for a volume such as this. We thank them for responding to their task so well and hope that you will feel as stimulated by their efforts as we have been. Eric Thomas John Rock ix Section A Scientific Aspects of Endometriosis 1 The pathogenesis and aetiology of endometriosis A. F. Haney INTRODUCTION Despite being one of the most frequently encountered gynaecological diseases requiring surgery and medical treatment, the pathophysiology of endometriosis remains controversial. Since the tum of the century, there has been substantial interest in this fascinating disease, but relatively little objedive scientific data are available concerning its cause, natural history and, particularly, its relationship to infertility. It has been estimated that approximately 10-15% of all premenopausal women have endometriosis, albeit not all the women are symptomatic!. As a consequence, this represents a major clinical problem and consumes a Significant proportion of the health care expenditures for gynaecological care. Until a better understanding of the pathophysiology of this disease is reached, effedive therapy and, hopefully, prevention will elude us. This article attempts to review the relevant literature regarding the pathophysiology of endometriosis in an effort to identify those areas that may prove profitable for future research endeavors. INCIDENCE In order to obtain the true incidence of endometriosis in a population of unseleded premenopausal asymptomatic women, the most sensitive diagnostic test, i.e. laparoscopy, would need to be performed prospedively. Obviously, such a trial is unethical and will never be completed. An alternative, although less accurate, approach is to estimate the incidence of this disease in women presenting with one of several symptoms justifying laparoscopy, i.e. pelvic pain, dysmenorrhoea and infertility. There are basically three types of studies 3
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