Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain.
European University Madrid, Villaviciosa de Odón, Madrid, Spain.
Int J Gynaecol Obstet. 2024 Oct;167(1):185-190. doi: 10.1002/ijgo.15541. Epub 2024 Apr 16.
To determine whether adenomyosis is present in the cornual portion of hysterectomies of symptomatic sterilization device users and in patients hysterectomized for different benign causes and who presented with pelvic pain and/or menstrual alterations.
An observational, analytical, cross-sectional, single-center, retrospective cohort study was conducted in a secondary level hospital. Cohort 1 consisted of women who had Essure® hysteroscopic sterilization devices inserted between 2009 and 2017, who developed gynecologic symptoms (pelvic pain, heavy menstrual bleeding, and/or abnormal uterine bleeding) and who underwent a hysterectomy for explantation of the devices. Cohort 2 consisted of women with the same gynecologic symptoms, who underwent a hysterectomy for other benign causes. All surgeries were performed by the gynecology team between 2018 and 2022. A descriptive and comparative analysis of sociodemographic, clinical characteristics, and pathologic findings between cohorts was made.
In total, 96 patients were studied (cohort 1 included 34 women, cohort 2 included 62 women). Pelvic pain was found to be more frequent in the cohort of Essure users (76.47% vs. 50%, P = 0.012), with a ratio of three times higher in this group (odds ratio 3.25, 95% confidence interval 1.27-8.28). Adenomyosis was more frequently found in the Essure group, both at corporal and cornual portions, the latter being five times higher in this cohort (relative risk = 5.47; 95% confidence interval 1.17-25.64).
The present study may be the first to describe cornual adenomyosis related to Essure devices. These devices may play a role in the development of adenomyosis and, consequently, pelvic pain. However, causality is difficult to establish.
确定在因症状性绝育装置使用者出现的子宫角部行子宫切除术的患者中以及在因不同良性原因且出现盆腔疼痛和/或月经改变而行子宫切除术的患者中是否存在子宫腺肌病。
在一家二级医院进行了一项观察性、分析性、横断面、单中心、回顾性队列研究。队列 1 由 2009 年至 2017 年间接受 Essure®宫腔镜绝育装置插入的女性组成，这些女性出现妇科症状（盆腔疼痛、月经过多和/或异常子宫出血）并因装置取出而行子宫切除术。队列 2 由因其他良性原因且出现相同妇科症状而行子宫切除术的女性组成。所有手术均由妇科团队在 2018 年至 2022 年期间进行。对两个队列的社会人口学、临床特征和病理发现进行描述性和比较分析。
共有 96 名患者入组研究（队列 1 包括 34 名女性，队列 2 包括 62 名女性）。Essure 用户组中发现盆腔疼痛更为常见（76.47%比 50%，P=0.012），该组的比值高 3 倍（优势比 3.25，95%置信区间 1.27-8.28）。Essure 组中更常发现子宫腺肌病，在子宫体和子宫角部均如此，后者在该组中高 5 倍（相对风险=5.47；95%置信区间 1.17-25.64）。
本研究可能首次描述与 Essure 装置相关的子宫角部腺肌病。这些装置可能在子宫腺肌病的发展中起作用，进而导致盆腔疼痛。然而，因果关系很难确定。
