leuprolide and Rectal-Diseases

The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.

Topics: Anal Canal; Conservative Treatment; Contraceptives, Oral, Combined; Danazol; Digestive System Surgical Procedures; Endometriosis; Endosonography; Estrogen Antagonists; Female; Humans; Intestinal Diseases; Laparoscopy; Leuprolide; Magnetic Resonance Imaging; Ovulation Inhibition; Pelvic Pain; Postoperative Complications; Progestins; Rectal Diseases; Ultrasonography

This study was undertaken to evaluate the effectiveness of a 6-month course of gonadotropin-releasing hormone agonist treatment for patients with symptomatic endometriosis of the rectovaginal septum.. Fifteen patients with rectovaginal endometriosis and moderate to severe pain symptoms were the subjects of the study. None of these patients had either clinical or objective evidence of ovarian endometriosis, nor was there evidence of any obstructive lesions of the intestine or ureters. All patients were given leuprolide acetate depot at 3.75 mg, 1 ampule intramuscularly every 28 days, and treatment had a planned duration of 6 months. Follow-up evaluations were set every 2 months during the treatment phase and every 3 months thereafter until the completion of 1 year after discontinuation of medical therapy. At each follow-up visit pain symptoms were recorded, and clinical exploration, transvaginal ultrasonography, and transrectal ultrasonography were performed.. Two patients stopped the treatment early after the second and fourth leuprolide doses; in both cases the reason was persistence of pain, and both requested a surgical solution. The other 13 patients showed a marked improvement with respect to pain during the 6-month treatment course but had early pain recurrence after drug suspension; 11 of them required further treatment within the first year of follow-up. The failure rate of gonadotropin-releasing hormone agonist therapy to produce 1-year pain relief after treatment discontinuation was 87% (13/15) on an intent-to-treat basis. The endometriotic lesions showed a slight but significant reduction in size during therapy but had returned to the original volume within 6 months after cessation of the gonadotropin-releasing hormone analog treatment.. Our results suggest that gonadotropin-releasing hormone analogs should not be considered a real therapeutic alternative to surgical treatment for patients with symptomatic endometriosis of the rectovaginal septum, except possibly in a limited and unpredictable number of cases.

Topics: Adult; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Pain; Rectal Diseases; Treatment Failure; Ultrasonography; Vaginal Diseases

A gonadotropin-releasing hormone agonist, leuprolide acetate, was administered every 4 weeks for treatment of rectovaginal endometriosis. Degrees of apoptosis (percentage of in situ deoxyribonucleic acid 3'-end-labeled cells) and cell proliferative activity (percentage of cells with immunostaining for proliferating cell protein Ki-67) were examined in endometriotic glands of biopsy specimens taken before and during gonadotropin-releasing hormone agonist therapy. Gonadotropin-releasing hormone agonist induced apoptosis and suppressed cell proliferative activity in endometriotic glands.

Topics: Adult; Apoptosis; Biopsy; Cell Division; Endometriosis; Female; Humans; Ki-67 Antigen; Leuprolide; Rectal Diseases; Vaginal Diseases

A woman with longstanding primary infertility and progressive, symptomatic rectal endometriosis was treated with daily leuprolide acetate for nine months. All bowel symptoms subsided. The patient was treated with human menopausal gonadotropin and intrauterine insemination prior to discontinuation of the leuprolide acetate, resulting in a twin pregnancy.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Endometriosis; Female; Humans; Infertility, Female; Insemination, Artificial, Heterologous; Leuprolide; Menotropins; Pregnancy; Rectal Diseases