Ovarian cyst sclerotherapy: a new innovative way of treatment

Abstract

Introduction : Whenever benign ovarian cysts, such as endometriomas, start to cause symptoms or greatly increase in size; a golden standard of surgery is a laparoscopic cystectomy. However, a new method has entered the surgery room – ovarian cyst sclerotherapy, which can be performed with various sclerosing agents, mostly with ethanol. Aim of the study: To review whether ovarian cyst sclerotherapy with ethanol can be as effective as laparoscopic cystectomy in endometriomas treatment. Material & Methods: A systematic review was based on the PRISMA guideline. Electronic literature search was carried out using keywords: “ovarian cyst sclerotherapy”,“endometriomas ethanol sclerotherapy”. Inclusion criteria: published less than 5 years ago, studies of ethanol sclerotherapy treatment of endometriomas under ultrasound control, meta-analysis, systematic reviews. Analysis of 225 articles was performed and 14 were included in this study. Results: One of the ways this procedure can be done consists of cyst aspiration and sclerosing agent injection under transvaginal sonography (TVS) control. Magnetic resonance imaging (MRI) of pelvis is strongly recommended before the procedure to eliminate any suspicion of malignancy. Some authors compared antral follicular count (AFC) andantimüllerian hormone (AMH) concentration in blood after the ethanol sclerotherapy procedure and laparoscopic cystectomy. The results showed significantly higher AFC and lower concentration of AMH afterwards. Some studies also came with higher pregnancy rates after cyst sclerotherapy compared to underwent laparoscopic surgery. The cyst recurrence rate was quite high and one of the reasons could have been not fully aspired content. Performed ovarian sclerotherapy shows higher effectiveness in pain syndrome management and it is a low-cost procedure as it does not require anaesthesia or any special equipment. One of the most serious but rare complications after the procedure is abscess caused by sclerosing agent leakage into the peritoneal cavity. Most likely women can experience not dangerous short-term pain in the abdomen or fever. Any unsuccessful ovarian sclerotherapy should be continued with urgent laparoscopic surgery. Conclusions: Ovarian cyst sclerotherapy under TVS is a low-cost and less technically complicated procedure with better pain syndrome management and preservation of ovarian reserve. However, higher recurrence rate and lack of evidence are the some of the few reasons why this procedure has not replaced the golden standard of laparoscopic cystectomy.