Chirurgia per idronefrosi cronico

Chirurgia per idronefrosi cronico In response to a question : how to treat silent hydronefrosis (without pain) and a marked reduction in kidney function ? AAGL-ENDO-EXCHANGE Digest - 7 Aug 2011 to 8 Aug 2011 Date: Mon, 8 Aug 2011 15:50:26 -0400 From: Philippe Koninckx and Anastasia Ussia <Gary_Frishman@BROWN.EDU> Subject: Chronic hydronephrosis surgical management In all cases seen with hydronephrosis until today (around 100): strategy has been consistently the same * insert a stent if possible * dissect the ureter what will give the diagnosis of the cause of the hydronephrosis ie generally endometriosis, rarely compression only. Anyway this becomes apparent during dissection. * during dissection decide whether excision of surrounding endometriosis is sufficient or whether a resection anastomosis is necessary (a reimplantation almost always is a secondary option after failure as published) Since dissection of the ureter was not done, I would suggest repeat surgery. The prognosis of the kidney function is difficult to predict since the duration that the hydronephrosis existed is unknown. Sincerely Philippe Koninckx and Anastasia Ussia Gruppo Italo Belga, Belgium and...

idronefosi, resezione intestinale inutile e endometriosi profonda

idronefosi, resezione intestinale inutile e endometriosi profonda per vedere la discussione completa in inglese AAGL-ENDO-EXCHANGE Digest - 28 Dec 2010 to 29 Dec 2010 (#2010-156)Date: Wed, 29 Dec 2010 20:00:34 -0500 From: Philippe R Koninckx Subject: 31 y.o. with firm rectovaginal mass and intermittent hydronephrosis To the ongoing discussion we would like to add some remarks, backed up with direct links to the articles referred to. 1. We fully agree with David Redwine that this lady needs surgical excision of all deep endometriosis. It is unclear whether LHRH agonists may be usefull. We do not recommend this since we have the impreesion that planes of cleavage become more difficult. 2. We do consider it a mistake to do IVF in a woman with a rectovaginal nodule as presented at the ESGE meeting in Amsterdam 2008. 3. In addition if the hydronefroses would not regress during an eventual pregnancy, it will become a painful decision what to do.(as I saw once) 4. We stronly oppose the concept of at team is required to treat the ureter. First for the lower ureter as written in Fertil steril last year ( http://www.gynsurgery.org/ols/pdf/2009_decicco_ureter.pdf ) any lesion can be treated conservatively and ureter reimplantation has no place anymore as a first line of treatment. Since in Europe mainly gynaecologists have the required skills and expertise for an eventual ureter reanastomosis, we recommended that the lower ureter should be considered part of gynaecology. Anyway the patient should be informed about the available skills otherwise informed consent cannot be obtained. ( http://www.gynsurgery.org/hysterectomy-myomectomy/surgical-mistakes-and-surgical-quality/ ) 5. In over 2000 deep endometriosis excisions of the rectum or rectosigmoid, a...

Consento Informato ed isterectomia

Consento Informato ed isterectomia Published on AAGL listserv Date: Mon, 29 Nov 2010 20:59:15 -0500 From: “Philippe R. Koninckx and Anastasia Ussia” <Gary_Frishman@BROWN.EDU> Subject:Informed consent and medicolegal exposure . Reading the last exchange of ideas, it seems important not to mix several issues. 1. Open hysterectomy versus laparoscopic hysterectomy. This is difficult to understand, given the legal obligation to obtain informed consent, which implies explaining the intervention and the alternatives. In Belgium, the latter moreover is obligatory. With the available evidence today, it seems highly unlikely, that any patient being explained the pro’s and cons will choose for open hysterectomy. If the alternatives were not explained and performs an open hysterectomy, the surgeon exposes himself to medico-legal action. 2. Robotic surgery. For a debate at the ESGE in Barcelone this year we reviewed the literature. Today there is no proven benefit in gynaecology, nor to the best of our knowledge in other disciplines. The increased costs associated with robotic surgery, however are obvious. 3. Tubal sterilisation. Important in this discussion is the often forgotten aspect of maintaining the possibility of reversal eg with Yoon ring or clips Philippe R. Koninckx and Anastasia Ussia Universities of Leuven, Belgium, Oxford UK and Rome Italy Gruppo Italo Belga, Rome...

endometriosi e bisfenolo

endometriosi e bisfenolo Recammente, nella stampa Italiana, il bisfenolo a considerata come la causa dell’endometriosi. 1. La relazione tra endometriosi e ‘endocrine disrupters’ ha inizio nel 1994 con un articolo di Koninckx seguito dall’articolo di Rier. Fino a oggi non è chiaro  se  vi è o meno questa  relazione . Suppratutto e inutile fare paura alle donne. 2.. Anche la storia del bisfenolo – un altro endocrine disrupter della  stessa famiglia- è gia vecchia e inizia con un bell’ articolo di Tsutsumi. e l’articolo di Newbold et al, 2005 . Come demonstrato prima per tanti altre estrogeni (stilbestrol e estogeno-like ) una dose forte supranormale puo creare problemi nel sviluppo genitali. Come dimostrato precedentemente  per tanti altre estrogeni (stilbestrol ed estogeno-like ) una  fortissima  dose può creare problemi nel sviluppo genitali. Il primo articolo nelle donne con endometriosi è di 2009 dimostrando che le donne con endometriosi hanno una  concentrazione di bisfenolo piu alto nel sangue. Non era chiaro se le concentrazioni erano sufficiente per far sviluppare un’endometriosi. 3. I dati recenti Signorile et al 2009 trovano ‘endometriosis-like lesions’ nelle topi.  Dal momento che non è chiaro  se queste lesiooni siano endometriosi, abbiamo (Ronald E. Batt, University at Buffalo, State University of New York, USA ,Lone Hummelshoj, Endometriosis.org, London, England,Charles Chapron, Université Paris Descartes, CHU Cochin, Paris, France ,Dan C. Martin, University of Tennessee Health Science Center, Memphis, USA, Glenna C. Bett, University at Buffalo, State University of New York, USA, John Yeh, University at Buffalo, State University of New York, USA, Philippe R. Koninckx, KULeuven Belgium; University of Oxford, UK; and Università Cattolica, Roma, Italy) gia scritto un...

Politica medica ed endometriosi

Politica medica ed endometriosi Sarà tradotto in breve tempo Endometriosis is apparently a hot topic with many scientifical controversies. In addition to the numerous and well organised patient organisations, political action and lobbying has become more prominent over the last years. As a consequence of this Endometriosis has been recognised as a social disease in Italy, while also in the EU endometriosis has been put on the political agenda. Recently the monthly newsletter of the WES had an editoreal criticising amonst other things, quality control in surgery. I quote ” You may have noticed a vicious war is raging. Between surgeons. About excellence………………………. It has even been suggested that there should be a camera in every OR and mandatory video registration to prevent abuse and permit quality control………………”. To understand this comment insight in the medical politics of endometriosis is necessary. First endometriosis is a misnomer and not always a disease.. Endometriosis was defined 100 years ago as endometrial cells outside the uterus. which is a microscopical description The real questions remains whether this is a disease, something abnormal. Although this sounds like a scientific discussion concerning pathophysiology, the medico polical background is important to understand . If typical cystic and deep endometriotic lesions are considered 3 different pathologies and 3 endpoints of a disease, without progress from one to the other the specific symptoms of each entity are straightforward. Endometriosis hence becomes a not recurrent disease, as other benign tumors as myoma’s, if surgery was complete. As for most benign tumors, a medical cure is not very realistic. The technical difficulty of complete laparoscopic excision of deep endometriosis...

Tests per il Diagnosi dell’Endometriossi possone essere pericolosi

Tests per il Diagnosi dell’Endometriossi possone essere pericolosi Habiamo avuto una discussione e-mail internazionale sulle problemi del diagnosi dell’endometriosi (in completo click qui) Following an international e-mail debate concerning research in endometriosis and political lobbying for endometriosis some comments are important. 1. The discussion and comments clearly demonstrated that the professional world of endometriosis remains divided between a few advanced surgeons (dealing with severe and deep endometriosis), infertility specialists dealing predominantly with superficial endometriosis, gynaecologists involved mainly in medical treatment and researchers. This already was addressed by discussing why “centers of excellence of endometriosis” could do more harm than good and why “centers of excellent surgery with quality control are needed”. 2. The delay in diagnosis remains a major issue and is caused by a series of factors such as lack of awareness, medical treatment given for longer periods without a diagnosis and lack of adequate referral. The solution of a simple non invasive diagnostic test, as proposed mainly by the non surgeons and the infertility/IVF/minor surgery specialist might however do more harm than good. A non invasive diagnostic test, unless 100% sensitive and 100% specific could cause problems as we are living today with MRI and ultrasound. Even for cystic ovarian endometriosis and even performed by experts sensitivity and specificity rarely exceeds 85%. If we really trust this diagnostic test this means that 15% of women will have surgery without a reason and that 15% will not have surgery although needed. When performed by non experts and for deep endometriosis it is much worse. A non invasive diagnostic test risks to meet the same problems of inducing unnecessary...