Extragenital endometriosis associated with uterine scar defects
Introduction: Uterine scar defects result from poor healing of the hysterotomy after cesarean sections (CS), in multiple cases leading to retroflexio uteri and retrograde menstruation. Endometriosis is the probable consequence. Patients often experience overlapping symptoms such as dysmenorrhea, dys...
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Elsevier
2025-06-01
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| Series: | European Journal of Obstetrics & Gynecology and Reproductive Biology: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590161325000225 |
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| author | Tilman Born Katrin Krejci Maximilian Rauh Georgia Cole Maurice Kappelmeyer Mehmet Vural Angela Köninger |
| author_facet | Tilman Born Katrin Krejci Maximilian Rauh Georgia Cole Maurice Kappelmeyer Mehmet Vural Angela Köninger |
| author_sort | Tilman Born |
| collection | DOAJ |
| description | Introduction: Uterine scar defects result from poor healing of the hysterotomy after cesarean sections (CS), in multiple cases leading to retroflexio uteri and retrograde menstruation. Endometriosis is the probable consequence. Patients often experience overlapping symptoms such as dysmenorrhea, dyspareunia, and infertility. Material and methods: This study analysed cases of sonographically detected uterine scar defects, subsequently undergoing laparoscopy at the University Clinic St. Hedwig, in Regensburg, between 2020 and 2024. Herefore, surgery reports were reviewed, focusing on extragenital endometriosis, symptoms of Cesarean Scar Disorder (CSD), niche morphology, uterine position, and endometriosis localisation using the #Enzian classification. Results: Extragenital endometriosis was histologically confirmed in 45 of 94 patients (47.9 %) with symptomatic or large uterine niches. A significant association was found between endometriosis and heavy menstrual bleeding (HMB) (p < 0.001) as well as retroflexio uteri (p = 0.036). Symptoms related to CSD did not differ in patients with or without Endometriosis. Endometriotic implants were primarily located in the peritoneum behind the uterus and sacrouterine ligaments, supporting the hypothesis of retrograde menstruation. Conclusion: There is significant overlap between the symptoms of endometriosis and CSD. Almost half of the patients with a symptomatic niche were found to have endometriosis, whereby the location of endometriosis supports the hypothesis of retrograde menstruation. However, the patient´s history of complaints is not indicative of the diagnosis of endometriosis. Therefore, all patients with CSD should be offered a laparoscopy and endometriosis surgery. All patients with a previous caesarean section presenting with symptoms of endometriosis should be offered standardised and high-quality niche diagnosis and treatment. |
| format | Article |
| id | doaj-art-5ca3d0555b9b435d8d58c0b2da26b62a |
| institution | OA Journals |
| issn | 2590-1613 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Journal of Obstetrics & Gynecology and Reproductive Biology: X |
| spelling | doaj-art-5ca3d0555b9b435d8d58c0b2da26b62a2025-08-20T02:06:32ZengElsevierEuropean Journal of Obstetrics & Gynecology and Reproductive Biology: X2590-16132025-06-012610038610.1016/j.eurox.2025.100386Extragenital endometriosis associated with uterine scar defectsTilman Born0Katrin Krejci1Maximilian Rauh2Georgia Cole3Maurice Kappelmeyer4Mehmet Vural5Angela Köninger6Corresponding author.; Department of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyDepartment of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyDepartment of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyDepartment of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyDepartment of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyDepartment of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyDepartment of Gynecology and Obstetrics, University of Regensburg, Clinic St. Hedwig, Steinmetzstrasse 1-3, Regensburg 93049, GermanyIntroduction: Uterine scar defects result from poor healing of the hysterotomy after cesarean sections (CS), in multiple cases leading to retroflexio uteri and retrograde menstruation. Endometriosis is the probable consequence. Patients often experience overlapping symptoms such as dysmenorrhea, dyspareunia, and infertility. Material and methods: This study analysed cases of sonographically detected uterine scar defects, subsequently undergoing laparoscopy at the University Clinic St. Hedwig, in Regensburg, between 2020 and 2024. Herefore, surgery reports were reviewed, focusing on extragenital endometriosis, symptoms of Cesarean Scar Disorder (CSD), niche morphology, uterine position, and endometriosis localisation using the #Enzian classification. Results: Extragenital endometriosis was histologically confirmed in 45 of 94 patients (47.9 %) with symptomatic or large uterine niches. A significant association was found between endometriosis and heavy menstrual bleeding (HMB) (p < 0.001) as well as retroflexio uteri (p = 0.036). Symptoms related to CSD did not differ in patients with or without Endometriosis. Endometriotic implants were primarily located in the peritoneum behind the uterus and sacrouterine ligaments, supporting the hypothesis of retrograde menstruation. Conclusion: There is significant overlap between the symptoms of endometriosis and CSD. Almost half of the patients with a symptomatic niche were found to have endometriosis, whereby the location of endometriosis supports the hypothesis of retrograde menstruation. However, the patient´s history of complaints is not indicative of the diagnosis of endometriosis. Therefore, all patients with CSD should be offered a laparoscopy and endometriosis surgery. All patients with a previous caesarean section presenting with symptoms of endometriosis should be offered standardised and high-quality niche diagnosis and treatment.http://www.sciencedirect.com/science/article/pii/S2590161325000225Cesarean Scar Defect (CSD)EndometriosisUterine Scar DefectRetrograde MenstruationLaparoscopyCesarean Section Complications |
| spellingShingle | Tilman Born Katrin Krejci Maximilian Rauh Georgia Cole Maurice Kappelmeyer Mehmet Vural Angela Köninger Extragenital endometriosis associated with uterine scar defects European Journal of Obstetrics & Gynecology and Reproductive Biology: X Cesarean Scar Defect (CSD) Endometriosis Uterine Scar Defect Retrograde Menstruation Laparoscopy Cesarean Section Complications |
| title | Extragenital endometriosis associated with uterine scar defects |
| title_full | Extragenital endometriosis associated with uterine scar defects |
| title_fullStr | Extragenital endometriosis associated with uterine scar defects |
| title_full_unstemmed | Extragenital endometriosis associated with uterine scar defects |
| title_short | Extragenital endometriosis associated with uterine scar defects |
| title_sort | extragenital endometriosis associated with uterine scar defects |
| topic | Cesarean Scar Defect (CSD) Endometriosis Uterine Scar Defect Retrograde Menstruation Laparoscopy Cesarean Section Complications |
| url | http://www.sciencedirect.com/science/article/pii/S2590161325000225 |
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