INTRODUCTION:
Endometriosis affects about 10% of women of reproductive age, causing pelvic pain syndrome, infertility, significantly reducing their quality of life. Despite the wide range of treatments available, the relapse rate reaches 38%, which is an unresolved problem
OBJECTIVE
To determine the clinical and anamnestic features of the recurrent course of the disease in patients with deep infiltrative endometriosis.
MATERIAL AND METHODS
A clinical and anamnestic examination of 113 patients of reproductive age who underwent surgical treatment of common forms of external genital endometriosis was carried out, including 32 patients with relapse of the disease (main group), 51 patients without relapse of the disease one year after the primary operation (comparison group) and 30 patients not suffering from external genital endometriosis (control group).
RESULTS
The recurrence rate of deep infiltrative endometriosis was 38%. Relapse of the disease clinically manifested itself in the form of chronic pelvic pain syndrome (85.7% (28/32) vs. 66% (34/52) patients in the comparison group, p=0.034), which was accompanied by dyspareunia (40.6% (13/32) in the long course of the disease vs. 39.2% (20/51), p=0.004), dysmenorrhea (71.9% (23/32) vs. 32.3% (10/30), p<0.001) and dyschezia (18.8% (6/30) vs. 9.8% (5/51), p=0.024).
Clinical predictors of the recurrent course of external genital endometriosis were: low body mass index (21.69 (2.86) kg/cm2 in the main group, vs. 24.68 (2.27) kg/cm2 in the comparison group and 23.38 (3.80) kg/cm2 in the control group, p<0.05), diseases of the gastrointestinal tract and functional bowel disorders (71.9% (23/32) vs. 51.3% (26/51) in the comparison group, p=0.006), diseases of the endocrine system (34.4% (11/32) vs. 9.4% (5/51) in the comparison group, p<0.05), which may be due to general pathophysiological mechanisms of disease development. Women with recurrent endometriosis are significantly more likely to suffer from infertility (56.3% (18/32) vs. 26.7% (8/30) in the control group, p=0.004) and have fewer pregnancies and births in their lives (90% (27/30) women in the control group vs. 62.5% (20/32) patients in the main observation group, p=0.025). Chronic anemia (46.9% (15/32) vs. 21.6% (11/51), p=0.026), significantly more common in women with recurrent deep infiltrative endometriosis, may be due to a more frequent combination of the disease with hyperplastic processes of the reproductive organs (28.1% (9/32) vs. 6.7% (2/30) in the comparison group, p=0.02).
CONCLUSION
The obtained clinical and anamnestic predictors of the recurrent course of deep infiltrative endometriosis will make it possible at the preoperative stage to take a set of measures aimed at preventing relapse of the disease, timely correcting the associated pathology and personalizing the choice of postoperative hormonal therapy.
