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How do you diagnose-treat Endometriosis?

NOTE**  This survey has no wrong or right answers. The only aim is to document what you do, and how this varies with country, age, gender and experience

How would you describe yourself:

YOUR ENDOMETRIOSIS PRACTICE

Who is doing your ultrasound examinations?
​How would you describe your expertise in Imaging?

Beginner

Expert

How would you describe your expertise in Medical therapy?

Beginner

Expert

How would you describe your expertise in Surgery: Superficial Endo?

Beginner

Expert

How would you describe your expertise in Surgery: Deep Endo?

Beginner

Expert

How would you describe your expertise in Surgery: Cystic Ovarian Endo?

Beginner

Expert

When do you decide to do a laparoscopy at age 18

Ex:  for a cyst of  1 cm + pain 1/10 a laparoscopy is not done

If only minimal pain, if pain is more severe than

No Pain

Severe Pain

When do you decide to do a laparoscopy at age 25

Ex:  for a cyst of  1 cm + pain 1/10 a laparoscopy is not done

At age 25: If only minimal pain, if pain is more severe than

No Pain

Severe Pain

When do you decide to do a laparoscopy at age 45

Ex:  for a cyst of  1 cm + pain 1/10 a laparoscopy is not done

Age 45: If only minimal pain, if pain is more severe than

No Pain

Severe Pain

Do other symptoms influence your decision to do a laparoscopy?

Severe pain radiation to the anterior side of the upper leg

No Pain

Severe Pain

Severe pain radiation to the perineum

No Pain

Severe Pain

Duration of Pain symptoms. Ex: more than 5 years in radiation to the perineum

No Pain

Severe Pain

Severe Adhesions estimated during US: Uterus and bowel

No Pain

Severe Pain

Severe Adhesions estimated during US: Fixed Ovary

No Pain

Severe Pain

Severe Adhesions estimated during US: Frozen pelvis

No Pain

Severe Pain

Preoperative Imaging: What is it used for?

To confirm my clinical diagnosis

Never

Always

To estimate the difficulty and risk of surgery: For the informed consent

Never

Always

To estimate the difficulty and risk of surgery: For planning the OR program

Never

Always

To estimate the amount of healthy ovarian tissue

Never

Always

To decide whether a bowel resection will be needed

Never

Always

To judge the parametrial infiltration

Never

Always

To judge Adenomyosis

Never

Always

Other imaging Exams as MRI

When do you use MRI

Never

Always

When US is inadequate

Never

Always

When US is well done

Never

Always

If a nodule of more than 3*3*3 cm

Never

Always

Before Surgery

Never

Always

Before starting medical therapy

Never

Always

If symptoms of bowel occlusion

Never

Always

Decision making in infertility

If no pain, and no obvious other infertility factors, a laparoscopy should be done

Never

Always

If no pain, coagulation of diaphragmatic endometriosis should be done

Never

Always

If no pain, Excision of typical endometriosis should be done for all lesions

Never

Always

Medical Therapy

I start medical therapy without a laparoscopy in women with pain and a neg clinical exam 18 y with dysmenorrhoea or chronic pain

Disagree

Agree

I start medical therapy without a laparoscopy in women with pain and a neg clinical exam 25 y with dysmenorrhoea or chronic pain

Disagree

Agree

I start medical therapy without a laparoscopy in women with pain and a neg clinical exam 35 y with dysmenorrhoea or chronic pain

Disagree

Agree

I continue medical treatment if after 6 months 18 y with dysmenorrhoea or chronic pain

Disagree

Agree

I continue medical treatment if after 6 months 25 y with dysmenorrhoea or chronic pain

Disagree

Agree

I continue medical treatment if after 6 months 35 y with dysmenorrhoea or chronic pain

Disagree

Agree

During medical treatment ultrasonic follow-up of growth of endo is needed

Disagree

Agree

Decision making: input of the patient

The patient can refuse interventions even if indicated during surgery: Appendectomy

Never

Always

The patient can refuse interventions even if indicated during surgery: Adnexectomy

Never

Always

The patient can refuse interventions even if indicated during surgery: Hysterectomy

Never

Always

The patient can refuse interventions even if indicated during surgery: Bowel surgery

Never

Always

The patient can refuse interventions even if indicated during surgery: Bowel resection

Never

Always

Complication risks: between 0.5 and 1% should be mentioned

Never

Always

Complication risks: between 1 and 2% should be mentioned

Never

Always

Decision making: how to organise surgery 

I feel strongly that, less experienced surgeons can do a laparoscopy and refer if necessary

Disagree

Agree

I feel strongly that, A cystic ovarian endometriosis of more than 4cm requires a skilled surgeon

Disagree

Agree

I feel strongly that, A preop ultrasound can predict the difficulty of rectum endometriosis

Disagree

Agree

I feel strongly that, A multidisciplinary surgical approach is better than a pelvic surgeon

Disagree

Agree

Surgery: superficial endometriosis

I feel strongly that, all superficial typical lesions should be excised or destroyed

Disagree

Agree

I feel strongly that, the pelvis should be scrutinized for small white vesicles

Disagree

Agree

I feel strongly that, if umbilical pain, a normal looking appendix should be removed

Disagree

Agree

Surgery:  Ureter

I feel strongly that, US is sufficient to exclude an hydronefrosis

Disagree

Agree

I feel strongly that, if no hydronefrosis, a double J should not be used

Disagree

Agree

I feel strongly that, For an hydronefrosis of > 2 cm, I do a resection anastomosis

Disagree

Agree

I feel strongly that, For an hydronefrosis of > 2 cm, Indocyanin green should check vascularisation

Disagree

Agree

Surgery: deep endometriosis of the bowel

I feel strongly that, Lymph nodes do not need to be removed (Although 18% have endometriosis)

Disagree

Agree

I feel strongly that, Excision can be done without safety limits (Although >50% endo at distance)

Disagree

Agree

Surgery: Nerves

I feel strongly that, severe menstrual sciatalgia needs an exploration of sciatic nerve

Disagree

Agree

I feel strongly that, the surgeon needs to know the dermatomes of Genito-femoral nerve

Disagree

Agree

I feel strongly that, the surgeon needs to know the dermatomes of ileo inguinal nerve

Disagree

Agree

I feel strongly that, the surgeon needs to know the dermatomes of ileo hypogastric nerve

Disagree

Agree

I feel strongly that, the surgeon needs to know the dermatomes of Crural nerve

Disagree

Agree

I feel strongly that, the surgeon needs to know the dermatomes of Crural nerve

Disagree

Agree

I feel strongly that, the surgeon needs to know the dermatomes of Sciatic nerve

Disagree

Agree

Surgery and Adhesions

I feel strongly that, incomplete endometriosis excision causes more adhesions

Disagree

Agree

I feel strongly that, barriers should be used systematically after surgery

Disagree

Agree

Sexuality and pain

I feel strongly that, Deep Endometriosis without pain decreases libido

Disagree

Agree

Surgery: postop

After surgery, a daily CRP is needed for Superficial endometriosis

Disagree

Agree

After surgery, a daily CRP is needed for Cystic ovarian endometriosis

Disagree

Agree

After surgery, a daily CRP is needed for Deep endometriosis involving the bowel

Disagree

Agree

After surgery, a daily CRP is needed for Bladder endometriosis

Disagree

Agree

Adolescent gynecology 

I think that, delay in diagnosis makes Endometriosis lesions worse

Disagree

Agree

I think that, Women of 18 need a laparoscopy, if before medical treatment pain > 6/10

Disagree

Agree

If during medical treatment pain >3/10

Disagree

Agree

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