By Paola De Nardi, Stefano Ferrrari, Elaine Denny

Deep pelvic endometriosis is without doubt one of the so much critical expressions of a illness which could contain the entire pelvic organs – bladder, ureters, rectosigmoid colon – inflicting debilitating signs and resulting in impaired caliber of lifestyles in younger women.
The chapters hide either diagnostic and healing points of this ailment. The principal position of diagnostic imaging in surgical determination making is highlighted, in addition to the problems enthusiastic about cautious making plans of surgical operation, and unique realization is paid to minimally invasive techniques.
The paramount significance of a multidisciplinary workforce, concerning the services of radiologists, gastroenterologists, and psychologists, in addition to the abilities of the gynecologist, urologist, and colorectal doctor is underlined during the text.

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GnRH analogs bring about a “functional oophorectomy”, that is, a state of pharmacologically induced hypogonadotropic hypogonadism. This, in turn, causes well-recognized side effects such as hot flashes and perspiration (80% to 90%), sleep disturbance (60% to 90%), vaginal dryness (30%), headache (20% to 30%), mood changes (depressive mood change because of estrogen withdrawal, more than 10%), osteopenia, loss of libido (more than 30%), and weight gain (about 15%). 1 Combined Treatment Approaches (Pharmacotherapy and Pain Therapy) In addition to surgery and pharmacotherapy, complementary treatments, whose efficacy has not been documented by scientific evidence, can be used.

Urol Clin North Am 2002;29:625–635 Vercellini P, Meschia M, De Giorgi O et al. Bladder detrusor endometriosis: clinical and pathogenetic implications. J Urol 1996;155:84–86 Seracchioli R, Mannini D, Colombo FM et al. Cystoscopy-assisted laparoscopic resection of extramucosal bladder endometriosis. J Endourol 2002;16:663–666 Bazot M, Thomassin I, Hourani R et al. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004;24:180–185 Carmignani L, Ronchetti A, Amicarelli F et al.

11 Computerized Tomography Computerized tomography (CT) is sometimes proposed as a diagnostic alternative for DIE, because of its importance in localization of endometriotic foci involving the urinary tract. The most important limitation of this technology is the ionizing radiation used. In recent years, CT has been substituted by MRI because of its high accuracy and noninvasiveness (Figs. 14). Fig. 13 CT image of a large bladder endometrioma (circled) 2 Diagnosis 39 Fig. 14 CT three-dimensional reconstruction of the urinary tract, in order to evaluate eventual ureteral involvement by the bladder endometrioma A new CT technique of computerized, multislice CT enteroclysis requires intestinal preparation, pharmacological hypotonization, and distension of the intestinal lumen by enteroclysis.

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