Joseph H. Pratt

Endometriosis in young women

Abstract Because endometriosis in young women may cause disabling pelvic symptoms and infertility, the authors reviewed the Mayo Clinic experience (1935 through 1964) to determine the frequency, relation to menarche, and outcome of endometriosis in such cases. Of 68 young patients having external endometriosis, 63 experienced menarche 5 to 10 years before diagnosis, 9 could not date menarche but were 21 or younger at diagnosis, and 6 had congenital obstruction to menstrual flow. Usually patients complained of dysmenorrhea or other pelvic pain, but 11 had no pelvic complaints. Only 3 complained chiefly of infertility. Ten patients initially had procedures ablating menstrual function, and 58 had conservative operations. One month to 25 years after conservative treatment, 15 patients required subsequent operation, radical in 12 cases. Since conservation of the childbearing function is the goal of treatment of young women, subsequent fertility (about 50 per cent in this series) is one measure of success.

EXENTERATIVE OPERATIONS: EXPERIENCE WITH 198 PATIENTS

In a series of 198 exenterative operations performed at the Mayo Clinic for various pelvic malignant lesions, a 5 year survival rate of 33 per cent was obtained. This rate is commendable, since almost 80 per cent of the operations were accomplished for recurrent malignancy. The diminished over-all operative mortality rate of 8.1 per cent, a reduction from 13.5 per cent (1950 through 1962) to 3 per cent (1963 through 1971), is attributed to better methods of urinary diversion and to better management of fluid replacement and of infectious complications. Major complications, excepting bowel fistula and obstruction, now can be controlled reasonably well. When more conservative and equally curative methods of therapy have been exhausted, all patients with pelvic malignancy (whether primary in cervix, vagina, bladder, urethra, rectum, or vulva) should be considered potential candidates for exenteration.