Journal List > Korean J Obstet Gynecol > v.54(8) > 1088315

Sung, Kim, Cho, Choo, Kim, and Yang: PROGNOSIS OF ENDOMETRIOSIS AFTER SURGICAL TREATMENT IN ADOLESCENTS BELOW 20 YEAR AGE

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.

Conclusion

Endometriosis can occur in adolescents and the recurrence rate is higher in advanced stage. As endometriosis is a progressive disease, early diagnosis and treatment during adolescence may be necessary.

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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).
kjog-54-448f1.tif
Table 1.
The distribution of the age at operation and menarche
Age of operation no. (%) Age of menarche no. (%)
11-14 3 (3.8) 10 4 (5.1)
15 2 (2.5) 11 4 (5.1)
16 5 (6.3) 12 14 (17.7)
17 9 (11.4) 13 25 (31.6)
18 10 (12.7) 14 21 (26.6)
19 14 (17.7) 15 10 (12.7)
20 36 (45.6) 16 1 (1.2)
Total 79 (100)   79 (100)
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)

a Ovarian benign tumor-except endometrioma.

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  

Data are presented as mean±standard deviati rAFS, revised American Fertility Society.

a P=0.005, likelihood ratio for trend.

b P<0.005

Table 4.
Associated Müllerian anomalies in patients with endometriosis
Age Menarche Diagnosis Operation
11 11 Double uterus with hematocolpus Left hemihysterectromy with left slapingo-oophorectomy
11 10 Double uterus with hydrosalpix Laparoscopic left hemihysterctomy
13 12 Double uterus with endometrioma Left hemihysterectromy enucleation of leftt ovarian cyst
16 13 Double uterus (transverse vaginal septum) with endometrioma Septotomy with laparoscopic left ovarian cyst enucleation
20 14 Double uterus (transverse vaginal septum) with endometrioma Laparoscopic right ovarian cyst enucleation
20 16 Double uterus (transverse vaginal septum) with hematocolpas Diagnostic laparoscopy with septotomy
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