Medical and Surgical Management of Endometriosis

  • Errico Zupi
  • Lucia Lazzeri
  • Caterina Exacoustos


Endometriosis is a chronic, multifactorial disease, affecting predominantly healthy young women with a negative impact on quality of life [1]. It is associated mostly with pelvic pain, dyspareunia, and intestinal disorders and can lead to infertility. Treatment of deep endometriosis (DE) can be either hormonal, aiming at inducing a hypoestrogenic state, atrophy or quiescence of endometriotic lesions, and a reduction of the chronic peritoneal inflammatory status, [2] or surgical, aiming at restoring the normal anatomy by removing endometriotic lesions. In order to plan an appropriate medical or surgical treatment of this condition, imaging (ultrasonography and magnetic resonance imaging (MRI)) is useful for assessing the number, size, and anatomical localization of the endometriotic nodules [3, 4].


  1. 1.
    Giudice LC, Kao L. Endometriosis. Lancet. 2004;364:1789–99.Google Scholar
  2. 2.
    Practice Committee of American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis. Fertil Steril. 2008;90:S260–9.Google Scholar
  3. 3.
    Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, Zupi E. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril. 2014;102:143–50.Google Scholar
  4. 4.
    Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27:2765–75.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Berlanda N, Somigliana E, Frattaruolo MP, Buggio L, Dridi D, Vercellini P. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67–71.PubMedGoogle Scholar
  6. 6.
    Bedaiwy MA, Alfaraj S, Yong P, Casper R. New developments in the medical treatment of endometriosis. Fertil Steril. 2017;107:555–65.PubMedGoogle Scholar
  7. 7.
    Ahmad G, O’Flynn H, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2012;2:CD006583.Google Scholar
  8. 8.
    Zupi E, Lazzeri L, Centini G. Deep endometriosis: less is better. J Endometr Pelvic Pain Disord. 2015;7:2.Google Scholar
  9. 9.
    Vercellini P, Somigliana E, Consonni D, Frattaruolo MP, De Giorgi O, Fedele L. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. Hum Reprod. 2012;27:3450–9.PubMedGoogle Scholar
  10. 10.
    Fedele L, Bianchi S, Zanconato G, Raffaelli R, Berlanda N. Is rectovaginal endometriosis a progressive disease? Am J Obstet Gynecol. 2004;191:1539–42.PubMedGoogle Scholar
  11. 11.
    Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015;21:329–39.Google Scholar
  12. 12.
    Vercellini P, Crosignani PG, Somigliana E, Berlanda N, Barbara G, Fedele L. Medical treatment for rectovaginal endometriosis: what is the evidence? Hum Reprod. 2009;24:2504–14.PubMedGoogle Scholar
  13. 13.
    Vercellini P, Giudice L, Evers JL, Abrao MS. Reducing low-value care in endometriosis between limited evidence and unresolved issues: a proposal. Hum Reprod. 2015;30:1996–2004.Google Scholar
  14. 14.
    Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101:927–35.Google Scholar
  15. 15.
    Vercellini P, Crosignani P, Somigliana E, Vigano` P, Frattaruolo MP, Fedele L. ‘Waiting for Godot’: a commonsense approach to the medical treatment of endometriosis. Hum Reprod. 2011;26:3–13.PubMedGoogle Scholar
  16. 16.
    Remorgida V, Abbamonte HL, Ragni N, Fulcheri E, Ferrero S. Letrozole and norethisterone acetate in rectovaginal endometriosis. Fertil Steril. 2007;88:724–6.PubMedGoogle Scholar
  17. 17.
    Muzii L, Tucci CD, Feliciantonio MD, Galati G, Verrelli L, Donato VD, Marchetti C, Panici PB. Management of Endometriomas. Semin Reprod Med. 2017;35:25–30.PubMedGoogle Scholar
  18. 18.
    Dunselman GA, Vermeulen N, Becker C, et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29: 400–12.PubMedGoogle Scholar
  19. 19.
    Leyland N, Casper R, Laberge P, Singh SS, SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010;32(7 Suppl 2):S1–S32.PubMedGoogle Scholar
  20. 20.
    Menakaya U, Infante F, Condous G. Consensus on current management of endometriosis. Hum Reprod. 2013;28:3162–3.PubMedGoogle Scholar
  21. 21.
    Harada T, Momoeda M, Taketani Y, Hoshiai H, Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2008;90:1583–8.PubMedGoogle Scholar
  22. 22.
    Vercellini P, Eskenazi B, Consonni D, et al. Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2011;17:159–70.PubMedGoogle Scholar
  23. 23.
    Vercellini P, de Giorgi O, Mosconi P, Stellato G, Vicentini S, Crosignani PG. Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis. Fertil Steril. 2002;77:52–61.PubMedGoogle Scholar
  24. 24.
    Seracchioli R, Mabrouk M, Manuzzi L, et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod. 2009;24:2729–35.PubMedGoogle Scholar
  25. 25.
    Vercellini P, Barbara G, Somigliana E, et al. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril. 2010;93:2150.PubMedGoogle Scholar
  26. 26.
    Kauppila A, Vierikko P, Isotalo H. Cytosol estrogen and progestin receptor concentrations and 17β-hydroxysteroid dehydrogenase activities in the endometrium and endometriotic tissue. Effects of hormonal treatment. Acta Obstet Gynecol Scand. 1984;63:45–9.Google Scholar
  27. 27.
    Vierikko P, Kauppila A, Ronnberg L, Vihko R. Steroidal regulation of endometriosis tissue: lack of induction of 17β-hydroxysteroid dehydrogenase activity by progesterone, medroxyprogesterone acetate, or danazol. Fertil Steril. 1985;43:218–24.PubMedGoogle Scholar
  28. 28.
    Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev. 2012;3:CD002122.Google Scholar
  29. 29.
    Hapgood JP, Africander D, Louw R, Ray RM, Rohwer JM. Potency of progestogens used in hormonal therapy: toward understanding differential actions. J Steroid Biochem Mol Biol. 2013;142:39–47.PubMedGoogle Scholar
  30. 30.
    Stanczyk FZ, Hapgood JP, Winer S, Mishell DR Jr. Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects. Endocr Rev 2013;34:171–208.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Vercellini P, Pietropaolo G, De Giorgi O, Pasin R, Chiodini A, Crosignani PG. Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril. 2005;84(5):1375–87.PubMedGoogle Scholar
  32. 32.
    Ferrero S, Camerini G, Ragni N, et al. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod. 2010;25:94.PubMedGoogle Scholar
  33. 33.
    Morotti M, Sozzi F, Remorgida V, Venturini PL, Ferrero S. Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment. Eur J Obstet Gynecol Reprod Biol. 2014;183:188–92.PubMedGoogle Scholar
  34. 34.
    Vercellini P, Bracco B, Mosconi P, Roberto A, Alberico D, Dhouha D, Somigliana E. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril. 2016;105:734–43.PubMedGoogle Scholar
  35. 35.
    Petraglia F, Hornung D, Seitz C, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012;285:167–73.PubMedGoogle Scholar
  36. 36.
    Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril. 2001;75:485–8.PubMedGoogle Scholar
  37. 37.
    Bayoglu Tekin Y, Dilbaz B, Altinbas SK, Dilbaz S. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011;95:492–6.PubMedGoogle Scholar
  38. 38.
    Abou-Setta AM, Houston B, Al-Inany HG, Farquhar C. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2013;1:CD005072.Google Scholar
  39. 39.
    Wong AY, Tang LC, Chin RK. Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2010;20:273–9.Google Scholar
  40. 40.
    Greenblatt RB, Dmowski WP, Mahesh VB, Scholer HF. Clinical studies with an antigonadotropin-Danazol. Fertil Steril. 1971;22:102–12.PubMedGoogle Scholar
  41. 41.
    Crosignani P, Olive D, Bergqvist A, Luciano A. Advances in the management of endometriosis: an update for clinicians. Hum Reprod Update. 2006;12:179–89.PubMedGoogle Scholar
  42. 42.
    Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Crosignani PG. Endometriosis: current therapies and new pharmacological developments. Drugs. 2009;69:649–75.PubMedGoogle Scholar
  43. 43.
    Igarashi M, Iizuka M, Abe Y, Ibuki Y. Novel vaginal danazol ring therapy for pelvic endometriosis, in particular deeply infiltrating endometriosis. Hum Reprod. 1998;13:1952–6.PubMedGoogle Scholar
  44. 44.
    Shaw RW. GnRH analogues in the treatment of endometriosis-rationale and efficacy. In: Thomas EJ, Rock JA, editors. Modern approaches to endometriosis. London: Kluwer Academic Publishers; 1990. p. 257–74.Google Scholar
  45. 45.
    Hornstein MD, Yuzpe AA, Burry KA, Heinrichs LR, Buttram VL Jr, Orwoll ES. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril. 1995;63:955–62.PubMedGoogle Scholar
  46. 46.
    Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up. Obstet Gynecol. 2002;99:709–19.PubMedGoogle Scholar
  47. 47.
    Prentice A. Regular review: endometriosis. BMJ. 2001;323:93–5.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Surrey ES. Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show? Curr Opin Obstet Gynecol. 2010;22:283–8.PubMedGoogle Scholar
  49. 49.
    Küpker W, Felberbaum RE, Krapp M, Schill T, Malik E, Diedrich K. Use of GnRH antagonists in the treatment of endometriosis. Reprod Biomed Online. 2002;5:12–6.PubMedGoogle Scholar
  50. 50.
    Finas D, Hornung D, Diedrich K, Schultze-Mosgau A. Cetrorelix in the treatment of female infertility and endometriosis. Expert Opin Pharmacother. 2006;7:2155–68.PubMedGoogle Scholar
  51. 51.
    Diamond MP, Carr B, Dmowski WP, et al. Elagolix treatment for endometriosis-associated pain: results from a phase 2, randomized, double-blind, placebo-controlled study. Reprod Sci. 2014;21:363–71.PubMedGoogle Scholar
  52. 52.
    Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2009;2:CD004753.Google Scholar
  53. 53.
    Hayes EC, Rock JA. COX-2 inhibitors and their role in gynecology. Obstet Gynecol Surv. 2002;57:768–80.PubMedGoogle Scholar
  54. 54.
    Dogan E, Saygili U, Posaci C, et al. Regression of endometrial explants in rats treated with the cyclooxygenase-2 inhibitor rofecoxib. Fertil Steril. 2004;82:1115–20.PubMedGoogle Scholar
  55. 55.
    Buelke-Sam J, Bryant HU, Francis PC. The selective estrogen receptor modulator, raloxifene: an overview of nonclinical pharmacology and reproductive and developmental testing. Reprod Toxicol. 1998;12:217–21.PubMedGoogle Scholar
  56. 56.
    Swisher DK, Tague RM, Seyler DE. Effect of the selective estrogen receptor modulator raloxifene on explanted uterine growth in rats. Drug Dev Res. 1995;36:43–5.Google Scholar
  57. 57.
    P. Fanning, T. J. Kuehl, R. Lee et al., Video mapping to assess efficacy of an antiestrogen (raloxifene) on spontaneous endometriosis in the rhesus monkey, Macaca mulatta. In TJ Kuehl, editor. Bunkley Day Proceedings. 1996; pp. 51–6.Google Scholar
  58. 58.
    Stratton P, Sinaii N, Segars J, et al. Return of chronic pelvic pain from endometriosis after raloxifene treatment: a randomized controlled trial. Obstet Gynecol. 2008;111:88–96.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Meresman GF, Bilotas M, Abello V, Buquet R, Tesone M, Sueldo C. Effects of aromatase inhibitors on proliferation and apoptosis in eutopic endometrial cell cultures from patients with endometriosis. Fertil Steril. 2005;84:459–63.PubMedGoogle Scholar
  60. 60.
    Velasco I, Rueda J, Acién P. Aromatase expression in endometriotic tissues and cell cultures of patients with endometriosis. Mol Hum Reprod. 2006;12:377–81.PubMedGoogle Scholar
  61. 61.
    Pavone ME, Bulun SE. Aromatase inhibitors for the treatment of endometriosis. Fertil Steril. 2012;98:1370–9.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Amsterdam LL, Gentry W, Jobanputra S, Wolf M, Rubin SD, Bulun SE. Anastrazole and oral contraceptives: a novel treatment for endometriosis. Fertil Steril. 2005;84:300–4.PubMedGoogle Scholar
  63. 63.
    Remorgida V, Abbamonte HL, Ragni N, Fulcheri E, Ferrero S. Letrozole and norethisterone acetate in rectovaginal endometriosis. Fertil Steril. 2007;88:724–6.PubMedGoogle Scholar
  64. 64.
    Ferrero S, Camerini G, Seracchioli R, Ragni N, Venturini PL, Remorgida V. Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. Hum Reprod. 2009;24:3033–41.PubMedGoogle Scholar
  65. 65.
    Lu D, Song H, Shi G. Anti-TNF-α treatment for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2013;3:CD008088.Google Scholar
  66. 66.
    Becker CM, Sampson DA, Short SM, Javaherian K, Folkman J, D’Amato RJ. Short synthetic endostatin peptides inhibit endothelial migration in vitro and endometriosis in a mouse model. Fertil Steril. 2006;85:71–7.PubMedGoogle Scholar
  67. 67.
    Jiang HQ, Li YL, Zou J. Effect of recombinant human endostatin on endometriosis in mice. Chin Med J. 2007;120:1241–6.PubMedGoogle Scholar
  68. 68.
    Dabrosin C, Gyorffy S, Margetts P, Ross C, Gauldie J. Therapeutic effect of angiostatin gene transfer in a murine model of endometriosis. Am J Pathol. 2002;161:909–18.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Oktem M, Esinler I, Eroglu D, Haberal N, Bayraktar N, Zeyneloglu HB. High- dose atorvastatin causes regression of endometriotic implants: a rat model. Hum Reprod. 2007;22:1474–80.PubMedGoogle Scholar
  70. 70.
    Esfandiari N, Khazaei M, Ai J, Bielecki R, Gotlieb L, Ryan E, et al. Effect of a statin on an in vitro model of endometriosis. Fertil Steril. 2007;87:257–62.PubMedGoogle Scholar
  71. 71.
    Sharma I, Dhawan V, Mahajan N, Saha SC, Dhaliwal LK. In vitro effects of atorvastatin on lipopolysaccharide-induced gene expression in endometriotic stromal cells. Fertil Steril. 2010;94:1639–46.e1.PubMedGoogle Scholar
  72. 72.
    Novella-Maestre E, Carda C, Ruiz-Sauri A, Garcia-Velasco JA, Simon C, Pellicer A. Identification and quantification of dopamine receptor 2 inhuman eutopic and ectopic endometrium: a novel molecular target for endometriosis therapy. Biol Reprod. 2010;83:866–73.PubMedGoogle Scholar
  73. 73.
    Delgado-Rosas F, Gomez R, Ferrero H, Gaytan F, Garcia-Velasco J, Simon C, et al. The effects of ergot and non-ergot-derived dopamine agonists in an experimental mouse model of endometriosis. Reproduction. 2011;142:745–55.PubMedGoogle Scholar
  74. 74.
    Ercan CM, Kayaalp O, Cengiz M, Keskin U, Yumusak N, Aydogan U, et al. Comparison of efficacy of bromocriptine and cabergoline to GnRH agonist in a rat endometriosis model. Arch Gynecol Obstet. 2015;291:1103–11.PubMedGoogle Scholar
  75. 75.
    Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;(3):CD003678.Google Scholar
  76. 76.
    Kennedy S, Bergqvist A, Chapron C, et al; ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20:2698–704.Google Scholar
  77. 77.
    Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70:1176–80.PubMedGoogle Scholar
  78. 78.
    Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82:1633–7.PubMedGoogle Scholar
  79. 79.
    Carmona F, Martínez-Zamora MA, Rabanal A, Martínez-Román S, Balasch J. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril. 2011;96:251–4.PubMedGoogle Scholar
  80. 80.
    Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;16:CD004992.Google Scholar
  81. 81.
    Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta- analysis. J Clin Endocrinol Metab. 2012;97:3146–54.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Pados G, Tsolakidis D, Assimakopoulos E, Athanatos D, Tarlatzis B. Sonographic changes after laparoscopic cystectomy compared with three-stage management in patients with ovarian endometriomas: a prospective randomized study. Hum Reprod. 2010;25:672–7.PubMedGoogle Scholar
  83. 83.
    Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94:71–7.PubMedGoogle Scholar
  84. 84.
    Muzii L, Panici PB. Combined technique of excision and ablation for the surgical treatment of ovarian endometriomas: the way for- ward? Reprod Biomed Online. 2010;20(2):300–2.PubMedGoogle Scholar
  85. 85.
    Donnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertil Steril. 2010;94:28–32.PubMedGoogle Scholar
  86. 86.
    Muzii L, Achilli C, Bergamini V, et al. Comparison between the stripping technique and the combined excisional/ablative technique for the treatment of bilateral ovarian endometriomas: a multicentre RCT. Hum Reprod. 2016;31:339–44.PubMedGoogle Scholar
  87. 87.
    Mircea O, Puscasiu L, Resch B, Lucas J, Collinet P, von Theobald P, Merviel P, Roman H. Fertility outcomes after ablation using plasma energy versus cystectomy in infertile women with ovarian endometrioma: a multicentric comparative study. J Minim Invasive Gynecol. 2016;23:1138–45.PubMedGoogle Scholar
  88. 88.
    Motte I, Roman H, Clavier B, Jumeau F, Chanavaz-Lacheray I, Letailleur M, Darwish B, Rives N. In vitro fertilization outcomes after ablation of endometriomas using plasma energy: a retrospective case-control study. Gynecol Obstet Fertil. 2016;44:541–7.PubMedGoogle Scholar
  89. 89.
    Roman H, Auber M, Mokdad C, et al. Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive. Fertil Steril. 2011;96:1396–400.PubMedGoogle Scholar
  90. 90.
    Angioli R, Muzii L, Montera R, et al. Feasibility of the use of novel matrix hemostatic sealant (FloSeal) to achieve hemostasis during laparoscopic excision of endometrioma. J Minim Invasive Gynecol. 2009;16:153–6.PubMedGoogle Scholar
  91. 91.
    Ghafarnejad M, Akrami M, Davari-Tanha F, Adabi K, Nekuie S. Vasopressin effect on operation time and frequency of electro- cauterization during laparoscopic stripping of ovarian endometriomas: a randomized controlled clinical trial. J Reprod Infertil. 2014;15:199–204.PubMedPubMedCentralGoogle Scholar
  92. 92.
    Muzii L, Marana R, Angioli R, et al. Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter? Fertil Steril. 2011;95:2116–9.PubMedGoogle Scholar
  93. 93.
    Kovoor E, Nassif J, Miranda-Mendoza I, Wattiez A. Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol. 2010;17:600–4.PubMedGoogle Scholar
  94. 94.
    Yohannes P. Ureteral endometriosis. J Urol. 2003;170:20–5.PubMedGoogle Scholar
  95. 95.
    Berlanda N, Vercellini P, Carmignani L, Aimi G, Amicarelli F, Fedele L. Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv. 2009;64:830–42.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Maccagnano C, Pellucchi F, Rocchini L, et al. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int. 2012;89:249–58.PubMedGoogle Scholar
  97. 97.
    Schneider A, Touloupidis S, Papatsoris AG, Triantafyllidis A, Kollias A, Schweppe KW. Endometriosis of the urinary tract in women of reproductive age. Int J Urol. 2006;13:902–4.PubMedGoogle Scholar
  98. 98.
    Vercellini P, Pisacreta A, Pesole A, Vicentini S, Stellato G, Crosignani PG. Is ureteral endometriosis an asymmetric disease? BJOG. 2000;107:559–61.PubMedGoogle Scholar
  99. 99.
    Scioscia M, Molon A, Grosso G, Minelli L. Laparoscopic management of ureteral endometriosis. Curr Opin Obstet Gynecol. 2009;21:325–8.PubMedGoogle Scholar
  100. 100.
    Ghezzi F, Cromi A, Bergamini V, Serati M, Sacco A, Mueller MD. Outcome of laparoscopic ureterolysis for ureteral endometriosis. Fertil Steril. 2006;86:418–22.PubMedGoogle Scholar
  101. 101.
    Mereu L, Gagliardi ML, Clarizia R, Mainardi P, Landi S, Minelli L. Laparoscopic management of ureteral endometriosis in case of moderate–severe hydroureteronephrosis. Fertil Steril. 2010;93:46–51.PubMedGoogle Scholar
  102. 102.
    Smith IA, Cooper M. Management of ureteric endometriosis 59 associated with hydronephrosis: an Australian case series of 13 patients. BMC Res Notes. 2010;3:45.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical 60 implications and proposition for a classification. Hum Reprod. 2003;18:157–61.PubMedPubMedCentralGoogle Scholar
  104. 104.
    Mmm Kondo W, Bourdel N, Tamburro S, et al. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG. 2011;118:292–8.Google Scholar
  105. 105.
    Azaïs H, Collinet P, Delmas V, Rubod C. Uterosacral ligament and hypogastric nerve anatomical relationship. Application to deep endometriotic nodules surgery. Gynecol Obstet Fertil. 2013;41:179–83.PubMedGoogle Scholar
  106. 106.
    Campagnacci R, Perretta S, Guerrieri M, et al. Laparoscopic colorectal resection for endometriosis. Surg Endosc. 2005;19:662–4.PubMedGoogle Scholar
  107. 107.
    Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod. 2010;25:1949–58.PubMedGoogle Scholar
  108. 108.
    Fanfani F, Fagotti A, Gagliardi ML, et al. Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case–control study. Fertil Steril. 2010;94:444–9.PubMedGoogle Scholar
  109. 109.
    Oliveira MA, Crispi CP, Oliveira FM, Junior PS, Raymundo TS, Pereira TD. Double circular stapler technique for bowel resection in rectosigmoid endometriosis. J Minim Invasive Gynecol. 2014;21:136–41.PubMedGoogle Scholar
  110. 110.
    Koh CE, Juszczyk K, Cooper MJ, Solomon MJ. Management of deeply infiltrating endometriosis involving the rectum. Dis Colon Rectum. 2012;55:925–31.PubMedGoogle Scholar
  111. 111.
    Moawad NS, Guido R, Ramanathan R, Mansuria S, Lee T. Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis. JSLS. 2011;15:331–8.PubMedPubMedCentralGoogle Scholar
  112. 112.
    Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012;98:564–71.PubMedGoogle Scholar
  113. 113.
    Wattiez A, Puga M, Albornoz J, Faller E. Surgical strategy in endometriosis. Best Pract Res Clin Obstet Gynaecol. 2013;27:381–92.PubMedGoogle Scholar
  114. 114.
    Kavallaris A, Banz C, Chalvatzas N, et al. Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients’ outcome. Arch Gynecol Obstet. 2011;284:131–5.PubMedGoogle Scholar
  115. 115.
    Keckstein J, Wiesinger H. Deep endometriosis, including intestinal involvement – the interdisciplinary approach. Minim Invasive Ther Allied Technol. 2005;14:160–6.PubMedGoogle Scholar
  116. 116.
    Leroy J, Costantino F, Cahill RA, et al. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg. 2011;98:1327–34.PubMedGoogle Scholar
  117. 117.
    Moustafa MM, Elnasharty MAA. Systematic review of the outcome associated with different surgical technique of bowel and rectovaginal endometriosis. Gynaecol Surg. 2014;11:37–52.Google Scholar
  118. 118.
    Koninckx P, Craessaerts M, Timmerman D, Cornillie F, Kennedy S. Anti- TNF-a treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial. Hum Reprod. 2008;23:2017–23.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Errico Zupi
    • 1
  • Lucia Lazzeri
    • 2
  • Caterina Exacoustos
    • 1
  1. 1.Department of Biomedicine and Prevention Obstetrics and Gynecological ClinicUniversity of Rome “Tor Vergata”RomeItaly
  2. 2.Department of Molecular and Developmental Medicine, Obstetrics and Gynecological ClinicUniversity of SienaSienaItaly

Personalised recommendations