A case of total laparoscopic hysterectomy for uterine cervical cystic adenomyosis. -Two techniques to avoid urinary tract injury-

Takashi Imai, Hiroshi Funamoto, Ayaka Yamaguchi, Shinichi Yoshikoshi, Rie Minami, Yuka Ametani, Satoshi Tanimura
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2019 · vol. 35(1) , pp. 238–242 · doi:10.5180/jsgoe.35.1_238 · W3156395109
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This case report describes total laparoscopic hysterectomy for uterine cervical cystic adenomyosis, detailing two specific techniques employed to prevent urinary tract injury during the procedure.

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This case report describes a 45-year-old woman with uterine cervical cystic adenomyosis and a history of endometriosis who underwent total laparoscopic hysterectomy due to worsening dysmenorrhea and lesion enlargement. The surgical team employed two specific techniques to prevent urinary tract injury in the presence of severe adhesions and anatomical changes: preoperative urinary catheter placement and intraoperative air injection into the bladder during dissection to monitor the bladder wall. Histopathology confirmed the diagnosis, and the patient experienced symptom improvement without recurrence post-surgery. This paper is centrally about adenomyosis — specifically the surgical management of rare cervical cystic adenomyosis using modified laparoscopic techniques.

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Abstract

Introduction: Uterine cystic adenomyosis is a rare proliferative disease in which the endometrial tissue focally repeats hemorrhage in the myometrium and forms cystic lesions. We report a case of uterine cervical cystic adenomyosis for which we performed total laparoscopic hysterectomy (TLH) with two techniques to avoid urinary tract injury.
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Introduction

Uterine cystic adenomyosis is a rare proliferative disease in which the endometrial tissue focally repeats hemorrhage in the myometrium and forms cystic lesions. We report a case of uterine cervical cystic adenomyosis for which we performed total laparoscopic hysterectomy (TLH) with two techniques to avoid urinary tract injury. Case: The patient was a 45-year-old woman with G0 who had two times of surgery for endometriosis. A local doctor diagnosed uterine cervical cystic adenomyosis about 30 mm in diameter and followed her up. Due to the worsening dysmenorrhea and the enlarging cystic lesion, she was referred to our hospital for treatment. Pelvic MRI showed uterine cervical adenomyosis about 35 mm in diameter and diffuse adenomyosis of the uterine body. TLH was performed because of the worsening dysmenorrhea due to uterine adenomyosis. Anatomical change due to a cervical tumor and severe adhesions because of endometriosis were expected; hence, we carried out two techniques. Firstly, urinary catheters were preoperatively placed, secondary, we injected air into the bladder when the uterus and the bladder were detached, then, TLH was safely completed while monitoring the bladder wall. Histopathology showed endometrial glands in the cervical myometrium, and uterine cervical cystic adenomyosis was diagnosed. Her symptoms have improved, and no recurrence after surgery has been observed.

Discussion

Cystic adenomyosis is rarer in the cervix than in the uterine body. There is no report about TLH for uterine cervical cystic adenomyosis. A difficult surgery was expected due to a cervical tumor and endometriosis, but the urinary tract injury was avoided using two techniques, and the surgery was safely completed. © 2019 日本産科婦人科内視鏡学会

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