Of the large number of gynecological diseases in this section, attention will be paid to the most important, which, in some cases, require surgical treatment. In the first place is infertility, as one of the most pressing issues today. Infertility and endometriosis are two closely related diseases, so the next chapter will discuss endometriosis.
Uterine pathology is no less urgent problem. Uterine leiomyoma (large nodes, nodes that deform the uterine cavity) and polyp, or endometrial hyperplasia of the uterine cavity - diagnoses that are often made during ultrasound (US) and require surgical treatment.
The next chapter describes in detail the problem pelvic organ prolapse and urinary incontinence. The options for treatment of this pathology are indicated.
Special attention is paid to emergency gynecology: ovarian apoplexy and ectopic pregnancy. These conditions occur suddenly and require urgent treatment. The chapter describes how to suspect this condition and see a doctor in time.
The main diseases treated by the doctor
Infertility
Unfortunately, an increasing number of couples are experiencing infertility problems. In 50-60% of cases the culprits are men. The male factor is ruled out quickly and painlessly: by taking sperm and examining it - performing a spermogram. The female factor is more complex and multifaceted.
One of the most common reasons for not getting pregnant is the tubal factor. If pregnancy does not occur within a year of regular sexual intercourse and there are no other infertility factors, the fallopian tubes should be checked.
Endometriosis
Endometriosis is a common gynaecological disease in which endometrial tissue, normally lining the uterine cavity, extends beyond the uterus to form endometrioid foci. According to the ESHRE (ESHRE guideline on endometriosis 2013), endometriosis affects between 2 and 10% of women of reproductive age and up to 50% of women with infertility.
Endometriosis is not a malignant disease and can be asymptomatic. The main symptoms are pain and infertility.
When endometrial tissue has grown inside the uterine wall, the diagnosis is uterine endometriosis (adenomyosis). This condition is called internal endometriosis. If the endometrioid tissue appears outside the uterus (in the ovaries, fallopian tubes, peritoneum), we speak of external endometriosis. When the ovaries are affected, cysts often form and the ovarian reserve is reduced. Therefore, endometriosis and infertility should not be postponed. Endometriosis seems to eat away at the ovarian tissue. An AMH (anti-müller's hormone) test is necessary to assess the potential of the ovary to become pregnant. This indicator will help develop further tactics.
Today there are medical and surgical treatments for endometriosis, which are often combined to achieve the desired effect
Uterine leiomyoma
Fibroid, fibroma and myoma are terms that refer to the same condition. In medical practice, this pathology is called leiomyoma. Uterine leiomyoma occurs in 20-40% of women over the age of 30, making it the most common tumour among women of childbearing age.
In most cases, the myoma nodules are small and require only follow-up monitoring (ultrasound check-up every 6-12 months). However, in 10-12% of cases, it requires treatment.
There is currently no cure for myoma. Existing medication is often ineffective and surgical treatment is recommended in such cases.
The indication for surgical treatment is made on an individual basis, but the main indications can be highlighted: size of the node over 6 cm, location of the node in the uterine cavity, uterine bleeding caused by the node.
The most common way to remove the nodules is by laparoscopy. If the nodes are located in the uterine cavity, hysterorectoscopy is used. If the uterus is severely affected and cannot be preserved, laparoscopic extirpation is performed.
Uterine cavity pathology
Among the pathological processes of the uterine cavity, the most common are: uterine polyps, endometrial hyperplasia, submucosal uterine leiomyoma, internal endometriosis, uterine synechiae.
Endometrial hyperplasia is an abnormal overgrowth of the uterine mucosa with predominantly glandular structures.
According to the WHO classification, hyperplastic endometrial processes include hyperplasia, polyps and atypical changes in the uterine mucosa.
Endometrial polyps can be detected against a background of endometrial hyperplasia as well as normal uterine mucosa in different phases of the menstrual cycle.
Hysteroscopy is used to diagnose and treat uterine abnormalities.
Pelvic organ prolapse. Urinary incontinence
A prolapse or prolapse of the vaginal and uterine walls is the most common pathology of the female genital system. Among the indications for routine surgical correction of uterine and vaginal prolapse, it ranks third after benign tumours and endometriosis. Nearly one in two women over the age of 50 faces this diagnosis.
In addition, patients with prolapse of the vaginal stump, cervical stump after uterine surgery: hysterectomy and supravaginal amputation are a group of patients with prolapse of the genitals.
The incidence of genital prolapse and urinary disorders increases with age. Urinary incontinence and frequent urge to urinate are found in 30% of women under 55 years of age and 75% of women under 70 years of age.
Urgent conditions requiring emergency surgery
Ovarian rupture (apoplexy)
Ovarian apoplexy, i.e. a ruptured ovary, most often occurs during sexual intercourse and requires urgent hospitalisation followed by treatment. The presence of intra-abdominal bleeding is an indication for urgent laparoscopic surgery. Most often, apoplexy occurs in the 2nd half of the menstrual cycle and manifests as a rupture of the corpus luteum of the ovary (corpus luteum cysts). The essence of the operation is to stop bleeding and remove blood and blood clots from the abdomen with minimal trauma to the ovary and preservation of all ovarian tissue.
Extrauterine pregnancy
An ectopic pregnancy is an abnormal pregnancy in which the foetus develops outside the uterine cavity. There are ovarian pregnancies, cervical pregnancies, abdominal pregnancies, etc. The most common pregnancy is in the fallopian tube (tubal pregnancy). This condition occurs at a rate of 1 per 100 pregnancies. The most frequent cause of ectopic pregnancies is an infectious inflammatory disease of the genitals, which may be triggered by abortions or frequent changes in sexual partners. The risk of ectopic pregnancy is also suspended in women who have had an ectopic pregnancy in the past and have retained the fallopian tube.
An ectopic pregnancy may be asymptomatic in its early stages. The diagnosis is made with an ultrasound scan of the pelvic organs.
If the pregnancy test is positive, you should contact your doctor immediately if any of the following symptoms occur:
• a scanty bloody or brown discharge from the genital tract;
• pulling pain and discomfort in the lower abdomen;
• nausea, vomiting.
If an ectopic pregnancy is suspected, immediate hospitalisation in an inpatient unit is required. If an ectopic pregnancy is detected, there is only one solution: removal of the gestational sac. This operation can be done either with preservation or removal of the fallopian tube. The fallopian tube is removed if the fallopian tube is severely deformed or there is a recurrent ectopic pregnancy.
The possibility of preserving the fallopian tube is decided on a case-by-case basis, in consultation with the patient, weighing up the pros and cons of each method.
The laparoscopic technique used in these cases allows for the least traumatic surgical intervention, resulting in a much shorter rehabilitation period and virtually no damage to internal organs.