Nicola Berlanda

• MD
• University of Milan

Infertility is commonly associated with endometriosis. Epidemiological studies suggest that the monthly probability of conception is about 2–5-fold lower in women with endometriosis than in normal couples. Considering infertile women, endometriosis has been diagnosed in about 25% of them, but marked differences are observed in this estimate among s...

STUDY QUESTION Is it possible to reduce the cost of GnRH agonist treatment for endometriosis by using non-standard dosing regimens? SUMMARY ANSWER An extended-interval dosing regimen of a 3.75 mg depot formulation of triptorelin injected every 6 weeks instead of every 4 weeks reduces the cost by one-third without compromising the effect on pain re...

We performed a comprehensive narrative synthesis of systematic reviews with meta-analysis published in the last five years on the association of endometriosis and adenomyosis with reproductive and obstetric outcomes. The aim was defining the information on which to base preconceptional counselling and clarifying whether and in which cases pregnant...

The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual mana...

Purpose of Review To investigate the reproductive outcome of infertile women with adenomyosis who undergo assisted reproductive technologies (ART) or conservative surgical treatment. Recent Findings Among 23 studies evaluating the outcome of ART, 12 compared women with adenomyosis with controls, while 11 included only women with adenomyosis, accou...

Objectives Previous evidence seems to support the more common presence of certain pigmentation types in women with endometriosis. The aim of this study was to assess the association of certain somatic phenotypes with specific localizations of the disease. The genetic makeup of those somatic traits may will help in better define the disease pathogen...

Purpose of Review To critically evaluate the most recent evidence on obstetric outcomes in women with adenomyosis. Recent Findings There is growing evidence suggesting an increased risk of obstetrical complications in women with adenomyosis. Summary An electronic search was conducted among the databases of PubMed, Google Scholar, and Cochrane rev...

Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous na...

Endometriosis infiltrating the bowel can be treated medically in accurately selected women not seeking conception and without overt obstructive symptomatology. When the rectosigmoid junction is involved, the probabilities of intestinal symptoms relief, undergoing surgery after treatment failure, and developing bowel obstruction during hormonal trea...

Objective: Ovarian hyper-stimulation during IVF is associated with a significant raise in serum estrogens and one may expect detrimental effects on estrogen-dependent diseases such as endometriosis. However, available evidence from large case series of affected women performing IVF is generally reassuring with the possible exception of women carry...

The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding...

Purpose of investigation: To report surgical treatment of a rare case of bilateral isolated fallopian tube torsion (IFTT). IFTT, especially when occurring bilaterally in adolescents, poses the dilemma of whether removing the salpinges, preventing the possibility of spontaneous conception, or restoring tubal patency, risking IFTT recurrence or a fut...

Background: The most frequent congenital anomalies of the genital tract in women are caused by irregular development of the Müllerian ducts. At present, known Müllerian anomalies include abnormal ductal unification, aplasia, and vaginal cysts. No cases of duplicated Müllerian ducts in females have been described previously. Case: A 33-year-old woma...

Endometriosis management seems to be influenced by outcome-independent biomedical, pharmacological, and technological developments. The propensity towards doing more affects several aspects of care, sometimes translating into proposals that are not based on sound epidemiological principles and robust evidence. Different stakeholders share the inter...

Purpose: We aim to provide a comprehensive overview of the role of the vagina as a route for drug delivery and absorption, with a particular focus on the use of vaginal hormonal compounds for the treatment of deep infiltrating symptomatic endometriosis. Methods: A MEDLINE search through PubMed was performed to identify all published studies in E...

Objective: To evaluate the feasibility, safety and outcome of the laparoscopic modified Davydov vaginoplasty in subjects with partial androgen insensitivity syndrome (PAIS). Design: Retrospective cohort study. Canadian task force classification of study design: III. Setting: Tertiary referral Center. Patients: Ten continuous patients opera...

It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future resear...

Endometriosis has a multifactorial etiology. The onset and progression of the disease are believed to be related to different pathogenic mechanisms. Among them, the environment and lifestyle may play significant roles. Diet, dietary supplements, physical exercise, osteopathy, massage, acupuncture, transcutaneous electrical nerve stimulation, and Ch...

G.A. has nothing to disclose. L.B. has nothing to disclose. N.B. has nothing to disclose. P.V. has nothing to disclose.

Despite higher costs for robotic assisted laparoscopy (RAL) than standard laparoscopy (SL), RAL treatment of endometriosis is performed without established indications. PubMed/MEDLINE was searched for 'robotic surgery' and 'endometriosis' or 'gynaecological benign disease' from January 2000 to December 2016. Full-length studies in English reporting...

The management of endometriosis-related infertility remains debated. However, in recent years, the role of in vitro fertilization (IVF) has progressively grown. Reasons to explain this change include (1) the improvement of the effectiveness and safety of IVF, (2) the raised awareness of the modest effectiveness of surgery, (3) the inherent risks of...

Endometriosis is characterized by frequent recurrences of symptoms and lesions even after extirpative surgery. Because medical therapies control but do not cure the disease, long periods of pharmacologic management may be needed until pregnancy desire or, sometimes, physiologic menopause. Hormonal drugs suppress ovulation and menstruation and have...

INTRODUCTION: Endometriosis is associated with an increased risk of dyspareunia, therefore this chronic gynaecologic disease should be considered as a major cause of sexual dysfunctions. The aims of this study were to review the literature on the effects of endometriosis surgical and pharmacological treatments on female sexual functioning, and to p...

Deep endometriosis, occurring approximately in 1% of women of reproductive age, represents the most severe form of endometriosis. It causes severe pain in the vast majority of affected women and it can affect the bowel and the urinary tract. Hormonal treatment of deep endometriosis with progestins, such as norethindrone acetate or dienogest, or est...

A panel of experts in the field of endometriosis expressed their opinions on management options in a 28-year-old patient, attempting pregnancy for one year, with severe cyclic pelvic pain and with clinical examination and imaging techniques suggestive of adenomyosis.

Introduction: All medical treatments for endometriosis are equally effective in relieving pain. However, all of them alleviate pain symptoms for as long as they are used, but pain always relapses when medication is discontinued. Therefore, medications need to be used in the long term. Areas covered: Formulations of estro-progestins that contain le...

Prior to the identification of diagnostic criteria for adenomyosis using modern imaging, the condition could only be diagnosed in hysterectomy specimens. The use of Magnetic Resonance Imaging and modern Ultrasound created the conditions for less radical treatment. This may include symptomatic treatment for heavy bleeding or dysmenorrhea, gonadotrop...

Objective: To describe the surgical technique and the long-term anatomic and functional results of laparoscopi-cally assisted uterovestibular anastomosis. Design: Descriptive study. Setting: Tertiary referral center. Patient(s): Twelve consecutive patients with uterine cervix atresia and vaginal aplasia. Intervention(s): Laparoscopically assisted u...

The risk of pregnancy and neonatal complications in women with endometriosis and adenomyosis is debatable. A literature review looking at rates, presentation, and management of spontaneous hemoperitoneum, enlargement, abscess, and rupture of an endometrioma, uterine rupture, and bowel perforation in pregnant women with endometriosis was conducted....

Several clinical and epidemiological studies demonstrated an association between endometriosis and infertility. A role in the genesis of infertility may be played by endometriomas, which may interfere with ovulation or damage ovarian tissue. Unlike peritoneal implants, the availability of an accurate noninvasive sonographic diagnosis facilitates th...

A panel of experts in the field of endometriosis expressed their opinions on management options in a 35-year-old patient, desiring pregnancy, with a previous surgery for endometrioma and with bowel obstructive symptoms. Many questions that this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A...

A panel of 29 experts in the field of endometriosis express their opinion on management options regarding a 35 years old patient, currently not desiring pregnancy, with moderate pelvic pain, and with an ultrasonographic diagnosis of bilateral endometriomas. Many questions that this paradigmatic patient may pose to the clinician are addressed, and a...

To review our experience with surgical treatment of ileocecal endometriosis. Observational study. Tertiary university hospital in Italy. Eight consecutive patients with infiltrating ileocecal endometriosis operated on between 2003 and 2005. All of the women underwent laparotomic ileocecal or cecal resection and had radical treatment of rectovaginal...

Surgery remains the standard treatment for endometriomas larger than 3 cm. Three to six months of hormonal treatment administered preoperatively does not facilitate surgery; additionally, treatment taken postoperatively delays but does not prevent endometrioma recurrence and thus does not offer substantial long-term advantages. Nevertheless, postop...

Analysis of published series reveals that no more than a fourth of subfertile patients undergoing surgery for peritoneal endometriotic implants, rectovaginal endometriotic lesions, or recurrent endometriomas achieved conception spontaneously. First-line surgery for ovarian endometriotic cysts appears associated with a better reproductive performanc...

OBJECTIVE: To evaluate serum antimüllerian hormone (AMH) level modification after surgical excision of ovarian endometriomas. DESIGN: Systematic review. MEDLINE search from January 1990 to April 2012 using the combination of medical terms endometriosis, endometrioma, endometriotic cyst, and AMH or antimüllerian hormone, MIF or müllerian inhibiting...

To evaluate the efficacy of second-line surgery in the management of recurrent endometriosis. Long-term probability of pain recurrence after repeat conservative surgery for recurrent endometriosis varies between 20 and 40%. The association of presacral neurectomy to the treatment of endometriosis might be effective in reducing midline pain; however...

Ureteral or vesical endometriotic lesions affect about 1% of women with endometriosis. The diagnosis may be difficult when specific symptoms are lacking. A delay in diagnosis can lead to significant morbidity. An adequate comprehension of the circumstances in which ureteral and vesical endometriosis present or should be suspected, aided by advances...

Rectovaginal endometriosis usually causes distressing pain. Surgical treatment may be effective but is associated with a high risk of morbidity and major complications. Information on the effect of medical alternatives for pain relief in this condition is scarce. A comprehensive literature search was conducted to identify all the English language p...

To describe the surgical technique and the long-term anatomic and functional results of laparoscopically assisted uterovestibular anastomosis. Descriptive study. Tertiary referral center. Twelve consecutive patients with uterine cervix atresia and vaginal aplasia. Laparoscopically assisted uterovestibular anastomosis was performed in all patients....

The main objective was to evaluate the diagnostic accuracy of a new questionnaire for the presurgical diagnosis of bladder endometriosis in patients with a high suspicion index for this disease. We included all patients of age <40 years undergoing laparoscopy or laparotomy for chronic pelvic pain. We partially modified the American Urologic Associa...

A 16-year-old woman experiencing primary amenorrhoea and cyclic pelvic pain was diagnosed with Rokitansky syndrome, which was characterized by the absence of the uterus and the upper two-thirds of the vagina, normal salpinges and ovaries and a 4 × 3cm Müllerian remnant containing functioning endometrium located near the left adnexa. With a combined...

To compare safety and effectiveness of two different instrument sets for the laparoscopic Vecchietti operation for the creation of a neovagina. Descriptive study. Tertiary referral center. Twenty-six women with Rokitansky syndrome. Twelve consecutive patients had surgery with the kit recently developed by Storz (group 1) and 14 consecutive patients...

This study was undertaken to evaluate structural and ultrastructural characteristics of the mucosa of neovaginae created by Vecchietti's laparoscopic operation for Rokitansky syndrome. Vaginoscopy and Schiller test were performed 3, 6, and 12 months after the operation in 106 patients. A biopsy specimen of the neovagina obtained 12 to 18 months aft...

To compare the laparoscopic excision of primary versus recurrent ovarian endometriomas. Descriptive study. Tertiary referral center for the treatment of endometriosis. Between 1993 and 2002, 359 consecutive patients: 305 primary surgeries (group A) and 54 reoperations for a recurrent endometrioma in the same ovary of the primary cyst (group B). Lap...

Current approved medical therapies for endometriosis rely on drugs that suppress ovarian steroids and induce a hypoestrogenic state, which determines the atrophy of the ectopic endometrium. Gonadotropin-releasing hormone analogs such as danazol, progestogens and estrogen-progestin combinations have all proven effective in relieving pain and reducin...

The purpose of this study was to assess the diagnostic accuracy of transvaginal sonographic examination of small adnexal masses by simple descriptive sonographic scoring. In a prospective multicenter study, 4 teaching hospitals and 2 regional hospitals with homogeneous standard sonographic equipment and operator experience recruited 677 consecutive...

The purpose of this study was to compare the outcome of standard extrafascial hysterectomy and tailored radical hysterectomy as a definitive treatment of recurrent deep endometriosis. This was a descriptive study that comprised 38 patients who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy between 1989 and 2002 for sympt...

To describe the long-term outcome of surgical conservative treatment of bladder endometriosis. Descriptive study. Tertiary referral center for the treatment of endometriosis. Forty-seven patients with symptomatic bladder endometriosis. Partial cystectomy by laparoscopy or laparotomy. Rates of recurrence at a 36-month follow-up. All 14 patients with...

To report our experience on laparoscopic resection of the cavitated noncommunicating rudimentary horn in 10 patients with unicornuate uterus. Descriptive study. A tertiary referral center for the treatment of female genital malformations. Ten consecutive patients operated between 1994 and 2002. Laparoscopic removal of the rudimentary uterine horn....

The purpose of this study was to observe the natural history of untreated asymptomatic rectovaginal endometriosis. This was a prospective, observational study. Eighty-eight patients with untreated asymptomatic rectovaginal endometriosis were followed for 1 to 9 years. Pain symptoms and clinical and transrectal ultrasonographic findings were evaluat...

To compare the functional ovarian damage associated with the use of bipolar coagulation versus ovarian suture after laparoscopic excision of ovarian endometriomas in patients with a solitary ovary. Retrospective study (Canadian Task Force classification II-3). Tertiary care center. Forty-seven consecutive women with a single ovary and regular mense...

To describe the conservative treatment of diffuse uterine leiomyomatosis. Descriptive study. Tertiary care centers. Three premenopausal women with diffuse uterine leiomyomatosis associated to persistent menorrhagia, two with desire of becoming pregnant and one with desire of preservation of the uterus. Preoperative ultrasound showed symmetrically e...

To evaluate fetal-maternal temperature relationship and fetal cardiovascular and metabolic response during maternal hypothermic cardiopulmonary bypass in pregnant ewes. Cardiopulmonary bypass was instituted in 9 pregnant ewes, reaching 2 different levels of maternal hypothermia: 24 degrees C to 20 degrees C (deep hypothermia) in group A (5 cases) a...

Medical treatment of endometriosis relies on drugs that suppress ovarian steroids and induce an hypoestrogenic state that causes atrophy of ectopic endometrium. Gonadotrophin-releasing hormone (GnRH) analogues, danazol, progestogens and oestrogen-progestin combinations have all proven effective in relieving pain and reducing the extent of endometri...

To investigate the feasibility of withdrawal of blood from the recipient twin as a new method for the treatment of severe twin-twin transfusion syndrome. Seven consecutive monozygotic monochorionic twin pregnancies affected by severe twin-twin transfusion syndrome were treated. Fetal blood was withdrawn from the recipient twin using cordocentesis....

To prospectively evaluate the accuracy of a multiparameter, ultrasound-based triage and its impact on surgical management of adnexal masses. Masses evaluated as normal according to Ferrazzi's sonographic morphological score were considered as being at low risk of malignancy and eligible for laparoscopic treatment without further evaluation. Masses...

To compare laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in patients with uterine fibroids. A prospective randomised study. The San Paolo Hospital, Milan. Sixty-two patients, who were not suitable for a vaginal hysterectomy, requiring treatment for uterine fibroids. Randomisation between LAVH and TAH....

To determine the safety and efficacy of laparoscopic management of ovarian dermoid cysts based upon our ten years' experience. Charts of 81 patients who underwent laparoscopic removal of dermoid cysts since March 1988 at Stanford University Medical Center or the Center for Special Pelvic Surgery in Atlanta were reviewed retrospectively. Ninety-thre...

This paper was originally published in Ultrasound Obstet Gynecol 1997; 10:192–7. The initials of the name of Dr Andrea A Lissoni were wrongly given as G. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology

Objective: The aim of this work was to compare the accuracy of a morphologic scoring system, to that of color-Doppler and to the integration of the two systems, to identify malignant ovarian masses by transvaginal ultrasound examination. Methods: One hundred and twelve adnexal masses were examined by transvaginal sonography within 48 hrs before sur...

The aim of this work was to test and compare the accuracy of five different morphological scoring systems to identify malignant ovarian masses in a prospective multicenter study. Four of the systems had previously been reported by Granberg, Sassone, De Priest and Lerner and the fifth is newly developed. A total of 330 ovarian neoplasms were collect...