What Is Oophorectomy?
Oophorectomy is the term that describes the surgical removal of one or both ovaries. Oophorectomy is otherwise known as ovariectomy. When one ovary is removed, this condition is known as unilateral oophorectomy. Removal of both ovaries is known as bilateral oophorectomy. Oophorectomy can also be done as a part of an operation that involves the removal of the uterus (hysterectomy).
This surgical procedure is done for several reasons. Oophorectomy is used to treat pelvic inflammatory disease, endometriosis, chronic pelvic pain, ectopic pregnancy, benign tumors, and large ovarian cysts.
In the case of women carrying mutations of BRCA1 or BRCA2 genes, oophorectomy can be performed to lower the risk of ovarian cancer. This procedure is known as an elective or prophylactic oophorectomy. Both estrogen and progesterone hormones are produced from the ovaries. Removal of both ovaries results in menopause and permanent infertility.
What Is Residual Ovary Syndrome?
Residual ovary syndrome (ROS) occurs when pieces of ovarian tissue are left in the body after a woman undergoes surgery to remove one or two ovaries (oophorectomy).
Residual ovary syndrome is otherwise known as ovarian remnant syndrome (ORS). These ovarian remnants can also re-implant themselves in the abdominal cavity, including the bladder, bowel, and ureters. This retained tissue can develop into a cyst or bleeding, causing debilitating pain.
This condition is caused due to several factors. The specific signs and symptoms observed are pelvic pain, formation of a pelvic mass, and absence of menopause after undergoing oophorectomy. Treatment is given for women experiencing symptoms and involves removing remnant tissue by surgery.
What Is the Cause Lying Behind Residual Ovary Syndrome?
The risk of residual ovary syndrome increases by incomplete removal of ovarian tissue at the time of oophorectomy. Several factors contribute to the incomplete removal of ovarian tissue. The crucial causes are pelvic adhesions, anatomical variations, and poor surgical procedures.
Adhesions are scar tissue bands that make the organs fuse or get stuck together. Pelvic adhesions often result from previous surgeries or pre-existing conditions such as endometriosis. Adhesions may cause difficulty for the surgeon to identify and remove ovaries because adhesions bind with other structures of the ovary or peritoneum (a serous membrane that lines the walls of the abdominal cavity).
Anatomical variations occur when ovaries remain located in unusual locations. Endometriosis also increases the risk of having remnant ovarian tissues because these remnants may stay embedded in the adjacent structures and makes complete excision of remnant tissues challenging. Finally, these remnant ovarian tissues remain unremoved. The risk of ROS also increases when an unskilled or inexperienced surgeon performs ovariectomy.
What Are the Risk Factors of Residual Ovary Syndrome?
Most patients develop residual ovary syndrome when they have a previous history of endometriosis or any other previous illness-causing pelvic adhesions. Residual ovary syndrome also occurs in patients who have undergone oophorectomy by an unskilled surgeon.
What Are the Symptoms of Residual Ovary Syndrome?
The main symptom of residual ovary syndrome is lack of menopause and continuous production of estrogen and progesterone following oophorectomy. The other symptoms are cyclic pelvic pain that coincides with the menstrual cycle and the formation of a pelvic mass. Some women may also experience painful intercourse, difficulty in urination, and painful bowel movements. In most cases, these symptoms occur within the first five years of oophorectomy. In rare cases, ROS may also happen after twenty years of oophorectomy.
How to Diagnose Residual Ovary Syndrome?
Residual ovary syndrome is often diagnosed in women with a previous history of oophorectomy followed by specific symptoms such as pelvic mass or persistent ovarian function. The doctor needs to know the reason behind the oophorectomy done.
It is necessary to know whether the affected person had endometriosis or prior abdominal or pelvic surgery and poor surgical visualization due to poor anatomical location of ovaries. The doctor may also advise a pelvic ultrasound to know the presence of a pelvic mass in ROS. Surgical exploration and biopsy of the remnant ovarian tissue help to confirm ROS diagnosis. Excision of the remnant ovarian tissue may also be done in the same procedure.
For women who have not undergone prior abdominal surgery, the clinical diagnosis of ROS is made based on the symptoms, hormone levels, and imaging. The doctor may also advise the affected women to do ultrasound, CT (computed tomography) scan, or MRI (magnetic resonance imaging) to diagnose the cause.
How to Treat Residual Ovary Syndrome?
Treatment for residual ovary syndrome is given based on the patient's symptoms. The mainstay of treatment involves surgery for removing residual ovarian tissue. Women having ROS with a pelvic mass need appropriate evaluation for malignancy. Hormonal therapy to suppress ovarian function is the alternative treatment for women who refuse surgery or patients who are unadvisable for surgery.
These ovarian remnants do not respond well to hormonal therapy in some cases. In such cases, laparoscopic surgery helps to remove ovarian remnants. Though this surgery remains challenging due to the scar tissues formed from previous surgeries, the improved visualization and accessibility provided by laparoscopy make the removal of remnants possible.
What Are the Preventive Measures to Be Taken to Avoid Residual Ovary Syndrome?
Residual ovary syndrome is a rare condition to occur. But this syndrome often develops in patients who had imprecise or incomplete surgery for removing one or both ovaries. Early surgical treatment of endometriosis might reduce the occurrence of pelvic adhesions, which makes incomplete removal of ovarian tissues more likely. The physician's skill in undergoing ovary removal surgery also plays an essential role in developing residual ovary syndrome.
What Are the Risks Faced When Residual Ovary Syndrome Is Left Untreated?
In undetermined cases, residual ovary syndrome does not cause any symptoms and remains untreated without causing any severe effects. In other instances, untreated residual ovary syndrome can cause the growth of cysts that might continue causing severe pelvic pain.
Conclusion:
As residual ovary syndrome occurs rarely, it is necessary to follow the health condition regularly after undergoing oophorectomy by consulting a doctor to prevent developing this syndrome.
