Conservative surgical treatment of adenomyosis to improve fertility: Controversial values, indications, complications, and pregnancy outcomes

Tsui KH, Kuan-Hao Tsui, Fa-Kung Lee, Lee FK, Kok-Min Seow, Kok‐Min Seow, Seow KM, Chang WC, Wei-Chun Chang, Wang JW, Jia-Wei Wang, Shee-Uan Chen, Shee‐Uan Chen, Hsiang-Tai Chao, Chao HT, Yen MS, Min-Shyen Yen, Wang PH, Peng-Hui Wang
Taiwanese journal of obstetrics & gynecology · 2015 · vol. 54(6) , pp. 635–640 · doi:10.1016/j.tjog.2015.05.003 · PMID:26700977 · W2198134313
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This review explores conservative surgical treatments for adenomyosis, examining their indications, complications, and impact on fertility outcomes compared to hysterectomy.

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Abstract

Uterine adenomyosis was first reported in the 19(th) century and early 20(th) century; von Rokitansky described it in 1860. Since then, the general clinical, pathological, and radiologic findings and potentially useful management methods have been reviewed in many studies. Some authors commented that conservative surgical treatment is impracticable as it is not possible to isolate the adenomyotic tissue adequately; therefore, the authors suggested that hysterectomy is the only rational and complete procedure. There is more evidence supporting the advantages of conservative uterine-sparing surgery in providing not only more effective symptom relief, but also longer durable symptom control for symptomatic women with uterine adenomyosis, because the main problem secondary to uterine adenomyosis, dysmenorrhea, can be improved significantly, up to 80%. Menorrhea was also improved in more than two-thirds of patients after type I uterine-sparing surgery, and half of the patients saw benefit in symptom control after type II conservative uterine-sparing surgery. In addition, there was no negative impact on reproductive performance after conservative uterine-sparing surgery, and in fact, reproductive performance seemed to be improved compared with that after medical treatment-not only was there a higher cumulative pregnancy rate, but also a higher cumulative final successful delivery rate. However, there is no doubt that the data supporting the above-mentioned benefits for symptomatic women with uterine adenomyosis after conservative uterine-sparing surgery are limited, suggesting that the benefit may be moderate. In fact, one of the main indications for surgery is temporary pain relief in women seeking spontaneous conception. However, the effect of surgery on pain is usually only temporarily satisfactory, and the risk of complications varies according to the type of lesion extirpated. In light of this, an extensive review of this topic addressing conservative surgical treatment for adenomyosis to improve fertility, including controversial values, indications, complications, and pregnancy outcomes, might be very important, and might help physicians in managing these patients in the future.

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Condition tags

dysmenorrheaadenomyosis

MeSH descriptors

Adenomyosis Infertility, Female Pregnancy Outcome Abortion, Spontaneous Abortion, Spontaneous Adenomyosis Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Fertility Preservation Humans Infertility, Female Infertility, Female Organ Sparing Treatments Postoperative Complications Pregnancy Pregnancy Rate

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (43)

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