Active clinical trials for "Endometriosis"

This is a prospective, Single time point, discovery study intending to identify biomarkers that can differentiate endometriosis from other underlying reasons for pelvic pain. Patients undergoing laparoscopy for evaluation of chronic pelvic pain or elective tubal ligation will be enrolled for collection of tissue samples at the time of laparoscopy.

The purpose of this study is to determine whether a relationship exists between a previously established diagnosis of endometriosis and the consecutive risk of developing a clear cell or endometrioid ovarian carcinoma. All histopathological records since 1980 with these diagnoses (endometriosis, clear cell and endometrioid ovarian carcinoma) will be reviewed. Cancer registry data will be assessed to investigate differences in survival of women with endometriosis-associated ovarian carcinomas and those ovarian carcinoma patients without previous diagnosis of endometriosis.

The recurrence of endometriosis after surgery a formidable challenge for the gynecologist. Recurrence rates reported in the literature are very high, being 21.5% at 2 years and 40-50% at 5 years. Several theories attempt to explain these high figures. The three most widely accepted are: The presence of residual endometriotic tissue or residual endometriotic cells not completely eradicated during surgery The growth of undetected microscopic endometriosis during surgery The development of endometriotic lesions de novo Patients with symptomatic endometriosis diagnosed by ultrasound or MRI and suitable for surgery will participate in the study. The surgical specimens sent for pathology from bladder, vagina, uterosacral, sigma or rectum will be properly marked for studying the presence of endometriosis.

This protocol seeks to assist biorepositories/biobanks in distributing their stored specimens and data to researchers that will actually utilize them to advance medicine and technology.

Several studies show a significant drop in pain scores, improved fertility outcomes and amelioration of impaired sexual functioning in women following surgical resection of colorectal endometriosis. However, intermediate and long-term bowel dysfunction may occur as a consequence of radical surgery with typical symptoms such as constipation, feeling of incomplete evacuation, clustering of stools and urgency. This is described as low anterior resection syndrome (LARS). The primary aim of this study is the prospective comparison of two surgical approaches for full thickness excision, i.e. transanal disc excision (TADE) and nerve-vessel sparing limited segmental resection (NVSSR), regarding gastrointestinal functional outcomes using the LARS / Gastrointestinal Quality of Life Index (GIQLI) by Eypasch questionnaires.

Assessment of the quality of life for patients suffering from isolated endometriosic lesion of utero-sacral ligaments diagnosed by MRI, before and after surgical treatment by using French version of Endometriosis Health Profile 30 (EHP 30). This is prospective, non-controlled, non-randomized, monocentric, observational feasibility study.

We therefore propose a research project based on the prospective evaluation of miRNAs (blood and salivary) in patients with endometriosis diagnosed (by clinical examination and imaging) or suspected of endometriosis (clinical/radiological discordance) and in need of management in routine care (surgical or medical PMA) in the Endometriosis Expert Center Hospital.

The aim of this study is to examine the incidence of deeply infiltrating endometriotic lesions among surgically treated endometriosis patients, and examine the impact of endometriosis, and its surgical treatment, on severity of pain symptoms, quality of life, and sexual functioning.

Background Deep infiltrating endometriosis (DIE) is most commonly located at the uterosacral ligaments, rectovaginal septum, pararectal space and vesicouterine fold. A nodule within the uterosacral ligaments (i.e involvement of the dorsal parametrium), increases the complexity of surgical resection. Parametrial involvement in DIE cases occurs in 25% of patients with severe endometriosis, possibly with hypogastric/sacral plexus or sciatic nerve involvement. The bladder functional impairment, after surgery for DIE involved the parametria, may vary between the 6.5% to 32.8%. Preservation of the hypogastric and pelvic splanchnic nerves represents the key aspect in pelvic surgery to prevent postoperative voiding disfunction. Several techniques for the excision of DIE have been described, but large, prospective RCTs are lacking. In particular, a clear standardization of the parametrectomy for DIE is missing. Systematic reviews on the surgical treatment of DIE demonstrated that it is impossible to compare the literature about the parametrectomy for DIE, because to unclear definitions and lack of standardization. We therefore believe it is necessary to propose a standardization of the definition of parametrectomy performed during procedures for DIE, to allow a clear comparison in the future between scientific works on surgical treatment of DIE, as already widely accepted in gynaecologic oncology with the classification of radical hysterectomy of Querleu-Morrow. In particular we believe that the parametrectomy for DIE must be described based on its anatomical extension and focused on the concepts of nerve sparing dissection, and vascular structures preservation, to reduce the risk of complications due to ischemia (i.e. ureter fistula). Rationale A standardized description of the procedure (parametrectomy) will allow the comparison between the different techniques in terms of functionality preservation of the pelvic sympathetic and parasympathetic neural pathway. Therefore, the availability of a clear classification able to define parametria involvement during surgery would be clinically relevant, as they would allow to optimize counselling (risk of neurological consequences) and surgery planning. Type of the study Multicentric prospective observational study. Primary objective To determinate the incidence of bladder functional impairment, after surgery for DIE involved the parametria. Secondary objectives To classify the parametrectomy into a clear system of classification, based on anatomical landmark, and evaluate intra/postoperative complication to each classes of proposed parametrectomy. Sample size The sample size has been calculated on the basis of the primary objective; in order to detect a proportion of bladder functional impairment of 30%, with a confidence level of 95% and a margin of error of 9%, a sample of N=100 patients is required. Inclusion criteria - Patient scheduled for surgery for DIE Confirmation of DIE needed of parametrectomy at laparoscopic surgery Exclusion criteria - Patients younger than 18 years and older than 50 years at time of operation Refusal to answer the questionnaires Absence of sexual activity Diagnosis of multiple sclerosis Pre-operative urodynamic diagnosis of neurogenic bladder dysfunction Statistical analysis The sample will be described in its clinical and demographic characteristics using descriptive statistics techniques. Qualitative variables will be summarized as frequencies and percentages. Quantitative variables will be presented as mean (std.dev). Normality of data will be checked with Kolmogorov-Smirnov test. The primary objective will be achieved calculating the incidence of bladder functional impairment after surgery. The secondary objective will be achieved using descriptive statistics techniques already described.

The women's clinic at Turku University Hospital has also since year 2000 accomplished and systematically increased advanced surgical treatment for the endometriosis patients with difficult disease. The aim is to centralize endometriosis treatment in the hospital district and by doing that be able to offer exact diagnosis, advanced surgical treatment and infertility treatment for every patient in the hospital area. The main purpose of this study is to find out how the operative treatment of endometriosis patients in Turku University Hospital is functioning and to see how the quality of life of these patients is before and after the surgery. Furthermore, the structure of the endometriosis patients' endometrium and the different markers of blood and urine are studied.