Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan; Department of Obstetrics and Gynecology, Doai Kinen Hospital, Japan.
Taiwan J Obstet Gynecol. 2022 Jul;61(4):606-611. doi: 10.1016/j.tjog.2022.02.044.
This study aimed to evaluate the course of long-term conservative management of bladder endometriosis (BE).
We retrospectively reviewed 17 cases of BE conservatively managed without surgery in our facility. The following factors were analyzed: age, medical history, lesion size, symptoms, hormonal treatment, and follow-up outcomes.
In this study, 15 patients received hormonal therapy and 2 did not. Oral contraceptive (OC), dienogest (DNG), and gonadotropin-releasing hormone agonist (GnRHa) were administered as the first regimen in 7, 5, and 3 patients, respectively. Of the 7 patients, OC administration was effective in alleviating urinary symptoms in all but 2 patients. Of 3 patients who received GnRHa, 2 switched to OC and then DNG, and 1 patient discontinued the treatment because of adverse effects. Of 5 patients who received DNG, all experienced symptom relief. DNG, OC, and GnRHa administration were effective and tolerable in 9 of 10 patients (90.0%), in 5 of 9 patients (55.6%), and in 2 of 3 patients (66.7%), respectively. In particular, 3 patients completed DNG treatment until menopause. The size of the BE lesion significantly decreased after 3 months of DNG administration, and the reduction effect was maintained until 48 months thereafter.
This study proposed that hormonal therapy for BE is an effective option for those who are not planning to conceive or to undergo surgery. Specifically, DNG may be suitable for patients refusing surgery, considering the effectiveness and tolerance for long-term use.
本研究旨在评估膀胱子宫内膜异位症（BE）的长期保守治疗过程。
我们回顾性分析了在我院接受非手术保守治疗的 17 例 BE 患者。分析了以下因素：年龄、病史、病变大小、症状、激素治疗及随访结果。
本研究中，15 例患者接受了激素治疗，2 例未接受。7 例患者给予口服避孕药（OC）、地诺孕素（DNG）和促性腺激素释放激素激动剂（GnRHa）作为一线治疗方案，分别有 7、5 和 3 例患者接受了 OC、DNG 和 GnRHa 治疗。7 例接受 OC 治疗的患者中，除 2 例患者外，其余患者的尿路症状均得到缓解。3 例接受 GnRHa 治疗的患者中，2 例转为 OC 后再转为 DNG，1 例因不良反应停止治疗。5 例接受 DNG 治疗的患者均症状缓解。在 10 例患者中，有 9 例（90.0%）患者接受 DNG、OC 和 GnRHa 治疗有效且可耐受，9 例患者中 5 例（55.6%）有效，3 例患者中 2 例（66.7%）有效。特别是 3 例患者完成了 DNG 治疗直至绝经。DNG 治疗 3 个月后，BE 病变大小显著缩小，且在其后 48 个月内维持了这一缩小效果。
本研究表明，对于那些不计划怀孕或手术的患者，激素治疗 BE 是一种有效的选择。特别是，对于拒绝手术的患者，考虑到长期使用的有效性和耐受性，DNG 可能是合适的治疗选择。
