OP19.07: Patterns of ultrasonographic changes of endometriosic cysts treated with progestins: usefulness as a criteria for surgical treatment timing

To evaluate the usefulness of ultrasonographic changes patterns after preoperative progestin treatment of endometriosic cysts for the optimal timing of laparoscopic surgery. We did a retrospective study of 250 patients with endometriosic cysts operated in the University Women's Hospital Cuza Voda Iasi during the period 1.01.2006–31.12.2011. 165 patients received treatment with progestins for at least 6 months preoperatively and 3 months postoperatively and 85 patients were operated without any hormonal treatment. The cysts were evaluated by vaginal ultrasound before treatment and at 1, 2 and 6 months. We assessed the cyst size, wall vascularisation, sludging, echogenicity, horizontal levels. After surgery the duration of intervention and subjective estimation of bleeding and easiness of capsula dissection were appreciated. A significant decrease of cysts diameter and vascularisation was found in most cases, usually associated with sludging and decreased hyperechogenicity. Horizontal levels and sludging usually appeared after the first three months of treatment and after their appearance the cysts size usually stabilised. Progestin treatment for a duration longer than 6 months preoperatively did not seem to bring any aditional benefit. Intraoperatively we noticed less bleeding during cyst dissection and a better cleavage plan between the cyst capsula and the normal ovarian tissue. 55% of the infertile patients obtained a pregnancy in the first year after laparoscopy and another 12% during the second year. Recurrence rates were 6% in the treated group and 17% in the untreated group. In our experience progestative treatment ameliorated operative conditions and decreased the recurrence risks in ovarian endometriosic cysts. The duration of progestative treatment free interval after operation is inversely proportional to the pregnancy chance and directly proportional to the recurrence risk.