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Abstract
Objective
To evaluate the clinical characteristics and prognosis of surgically treated endometriosis in adolescent women below 20 year age.
Methods
A retrospective review was conducted on patients diagnosed endometriosis on operation below 20 year age at Cheil General Hospital between January 2001 and October 2010. Clinical characteristics, treatment results and follow-up data for 79 women were collected.
Results
The mean age at operation was 18.5 year age, and in 5 cases (6.3%) the operation was performed at ≤ 15 year age. Müllerian anomalies were accompanied in 6 cases (7.6%). Seventy-nine per cent of patients had pain associated symptoms such as dysmenorrhea, non cyclic pelvic pain, and gastrointestinal pain. Endometriosis was found to be stage I in 20.3% of patients, stage II in 7.6% of patients, stage III in 40.5% of patients and stage IV in 31.6% of patients. We could not find any recurrence in patients with stage I and II endometriosis, however patients with stage III and IV endometriosis showed recurrence rates of 15.6% and 28.0%, respectively, during the mean follow-up period (33.7 ± 28.5 months). During the 36-month follow-up, the cumulative proportion of subjects free from endometrioma recurrence was 82.5%, but the rate increased as the follow-up period was extended.
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Fig. 1.
(A) Cumulative recurrence of endometriomas during the follow up period. (B) Cumulative recurrence of endometriomas according to the stage of endometriosis during the follow up period (dark line; stage III, dotted line; stage IV).
Table 1.
The distribution of the age at operation and menarche
Table 2.
Symptoms and preoperative diagnosis before surgical treatment of endometriosis
| no. (%) | |
|---|---|
| Presenting Symptoms | |
| Dysmenorrhea | 39 (49.4) |
| Non cyclic pain | 22 (27.9) |
| Palpable mass | 9 (11.4) |
| Incidental finding | 5 (6.3) |
| Gastrointestinal pain | 2 (2.5) |
| Preoperative diagnosis | |
| Endometrioma | 43 (54.4) |
| Ovarian benign tumora | 17 (21.5) |
| Ovarian malignancy | 4 (5.0) |
| Ovarian torsion | 7 (8.9) |
| Uterine anomaly | 2 (2.5) |
| Inflammatory mass | 1 (1.3) |
| Hemoperitoneum | 4 (5.1) |
| Ectopic pregnancy | 1 (1.3) |
Table 3.
Analysis of clinical characteristics associated with recurrence of endometriomas after the first line surgery
| No recurrence after the operation | Recurrence after the operation | P-value | |
|---|---|---|---|
| Age | 18.5 ± 2.0 | 18.9 ± 1.3 | 0.47 |
| Body mass index | 20.8 ± 3.0 | 20.1 ± 3.8 | 0.49 |
| Largest cyst size at operation | 7.4 ± 5.7 | 8.3 ± 5.3 | 0.61 |
| Follow-up months | 18.5 ± 2.0 | 67.0 ± 30.5 | 0.00a |
| Menarche | 13.1 ± 1.3 | 13.2 ± 1.4 | 0.91 |
| Nature of the cysts (total 55 cases) | |||
| Unilateral | 36 | 8 | 0.39 |
| Bilateral | 7 | 4 | |
| r-AFS Stage | 0.01b | ||
| I | 15 | 0 | |
| II | 6 | 0 | |
| III | 28 | 5 | |
| IV | 18 | 7 | |
| Post op medication | 0.53 | ||
| N | 31 | 4 | |
| Y | 36 | 8 |
Table 4.
Associated Müllerian anomalies in patients with endometriosis
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