Sonovaginography (Endometriosis ultrasound)
Endometriosis is a disease of nearly 1 million Polish women. It is usually associated with extreme pain, heavy periods, infertility and sometimes depression. Despite the fact that the disease occurs in such a large group of women, its diagnosis is extremely difficult, sometimes it takes even 8 years from the first symptoms to make a proper diagnosis. Meanwhile, the disease does not wait. Untreated endometriosis develops constantly, wreaking havoc on the body. That is why it is so important to go to a specialist at the first worrying symptoms, who thanks to his experience and knowledge will recommend an appropriate diagnosis, so that the right treatment can be implemented quickly.
One of the most readily available, inexpensive and effective methods of diagnosing this condition is transvaginal ultrasound, performed by a doctor specialised in the diagnosis of this condition. At the clinic Invimed Wrocław and Invimed Gdynia patients are offered a specialised ultrasound examination using gel contrast called sonovaginography.
What is endometriosis?
Endometriosis is a disease in which the endometrium, or endometrium, appears in places where it should not be, i.e. outside the uterine cavity. Ectopic endometrial cells most often locate in the abdominal cavity on the peritoneum and the organs within it - intestines, liver, ureters, bladder diaphragm muscles. Endometrial foci They can also occur deep in the tissues of the body, i.e. in the rectovaginal septum, in the vaginal vault, in the cervix or on the vulva.
Endometrial fociwhich are located in other organs undergo the same hormone-induced changes as the endometrium in a woman's uterus during her monthly cycle. The endometrium flakes off, causing bleeding and damage to the tissues it has invaded. This exposes the woman to a number of unpleasant and inconvenient symptoms such as abdominal pain, diarrhoea alternating with constipation, painful periods and bleeding and spotting between periods, painful defecation or frequent urination.
The excruciating pain, which involves the pelvic area, lower abdomen and back, intensifies during menstruation and sometimes ovulation. In addition, painful intercourse, headaches, chronic fatigue or infertility and miscarriages are often associated with the condition.
How to diagnose endometriosis?
Diagnosis of endometriosis by means of a meticulous medical history and a detailed gynaecological examination may sometimes not be sufficient. Usually, an advanced ultrasound examination (sonovaginography) is carried out and the diagnosis is further expanded to include MRI, or magnetic resonance imaging, especially at the stage of planning the extent of the operation. Laparoscopy is sometimes performed, but according to the latest ESHRE (European Society for Human Reproduction and Embryology) guidelines, this method should not be used for the routine diagnosis of endometriosis. It should only be used if there is a therapeutic purpose - to reduce pain or improve fertility.
Biomarkers are also used to diagnose endometriosis (determination of CA-125 blood levels) and the latest innovative test developed by Polish scientists - EndoRNA qRT-PCR, which determines the expression level of the gene encoding fucosyltransferase 4 (FUT4), associated with the occurrence of endometriosis, even if not visible on ultrasound. It is a complementary test to imaging studies, determines the likelihood of developing this disease in the future and also confirms the atypical location of the foci, e.g. in the eye, brain or lungs. This examination is performed in a minimally invasive manner, taking a painless fragment of endometrium from the uterine cavity in the middle of the menstrual cycle.
Sonovaginography - ultrasound examination of deeply infiltrating endometriosis (DIE)
Standard ultrasound examination can identify individual ovarian endometrial cysts, but it may not be possible to detect foci in other locations in the abdominal cavity. Failure to identify endometrial cysts in the ovaries does not exclude the presence of foci of superficial and deeply infiltrating endometriosis in other locations. If their presence is suspected, a specialised examination with gel contrast (so-called sonovaginography) should be performed by a specialist in this field.
The study is aimed at patients with suspected deep infiltrating endometriosis. This is the most advanced form of the disease, in which endometriosis tissue infiltrates the peritoneum to a depth of more than 5 mm. This form of endometriosis, can lead to narrowing of the intestinal lumen and obstruction, narrowing of the ureter and hydronephrosis with loss of the kidney in the future, damage to the bladder, lungs or diaphragm or infiltration of the nerves causing chronic neuropathy.
What are the indications for sonovaginography (endometriosis ultrasound)?
Endometriosis ultrasound should be performed in patients who present with symptoms that may suggest deeply infiltrating endometriosis. These include:
-
lower abdominal pain during menstruation,
-
pains during intercourse,
-
bladder pain,
-
low back pain,
-
infertility and miscarriages,
-
diarrhoea, constipation, abdominal bloating.
How is the test (endometriosis ultrasound) performed?
Sonovaginography is performed using a vaginal probe. Prior to the examination, the doctor uses a special catheter to introduce a gel into the vagina, which acts as a contrast agent. This allows him or her to identify endometriosis on ultrasound at a much more sensitive level than during a standard ultrasound.
In the first stage, the kidneys are examined to rule out possible urinary stasis, which may be caused by ureteral stricture in the course of endometriosis. The doctor assesses the reproductive organ, i.e. the cervix, the uterine body and the ovaries. In addition, the mobility of the ovaries and uterus is assessed.
This can be followed by a thorough assessment of the area around the anterior vaginal wall, bladder, posterior vaginal wall, rectovaginal septum and rectum for foci of deeply infiltrating endometriosis.
The examination takes approximately 30 minutes. It is painless.
Ideally, sonovaginography should be performed in the first phase of the cycle after the end of menstruation.
Deeply infiltrating endometriosis is the most severe form of endometriosis, so its diagnosis requires special skills of the person who performs this examination and is able to use the capabilities of highly specialised ultrasound equipment. Only in this way is it possible to make a correct assessment and a reliable and accurate diagnosis.
How much does sonovaginography (endometriosis ultrasound) cost for endometriosis?
The 30-minute examination is currently being performed at a promotional price of £600.
Where to perform endometriosis ultrasound (sonovaginography)?
Sonovaginography is available in Invimed Clinic Gdynia. This study at expert level is performed by: Dr Kajetan Piatkowski. Medical director of Invimed Gdynia. Completed practical training and participated in diagnostic workshops at Medicover Hospital in Warsaw.
Sonovaginography is performed at the Invimed Clinic in Wrocław.
In Wrocław, the test is performed by doctor Małgorzata Zembala-Szczerba - Specialist obstetrician gynaecologist. Her daily practice is guided by the idea of a holistic approach to patients. The work is based on current knowledge and scientific reports, takes into account each woman's individual decisions and cooperation in creating health. As a woman and mother, she understands the problems of her patients well, which allows for support and empathy.
Sonovaginography is performed at the Invimed clinic in Poznan.
In Poznań, the test is performed by dr n. med. Dorota Kuśnierczak Medical Director of Clinicsi Specialist gynaecologist-obstetrician graduate of the Poznan University of Medical Sciences, an accomplished physician with a doctorate from Humboldt University in Berlin.
Sonovaginography is performed at the Invimed clinic in Katowice.
In Katowice Patrycja Sadowska, MD, Medical director of Invimed Katowice, specialist gynaecologist-obstetrician, endocrinologist, a doctor with international experience: at Kings College Hospital, Harris Birthright Research Centre in London, at Inner Vision Women's Ultrasound in Nashville, Tennessee USA and at Hadassah Medical Centre in Jerusalem, Israel in the Infertility Treatment Unit.