Megan Kennedy Burns | University of Rochester (original) (raw)

Papers by Megan Kennedy Burns

About 10% of all reproductive-aged women and 35% to 50% of women with pelvic pain and infertility... more About 10% of all reproductive-aged women and 35% to 50% of women with pelvic pain and infertility are affected by endometriosis. The disease typically involves the reproductive tract organs, anterior and posterior cul-de-sacs, and uterosacral ligaments. However, disease outside of the reproductive tract occurs frequently and has been found on all organs except the spleen. The bowel is the most common site for extragenital endometriosis, affected in an estimated 3.8% to 37% of patients with known endometriosis. Implants may be superficial, involving the bowel serosa and subserosa (FIGURE 1), or they can manifest as deeply infiltrating lesions involving the muscularis and mucosa (FIGURE 2, page 38). The rectosigmoid colon is the most common location for bowel endometriosis, followed by the rectum, ileum, appendix, and cecum (FIGURES 3, 4, and 5, pages 38-39). Case reports also have described endometrial implants on the stomach and transverse colon. Although isolated bowel involvement ...

acterized by endometrial glands and stroma outside of the uterine cavity. It is commonly associat... more acterized by endometrial glands and stroma outside of the uterine cavity. It is commonly associated with pelvic pain and infertility. Ectopic endometrial tissue is predominantly located in the pelvis, but it can appear anywhere in the body, where it is referred to as extragenital endometriosis. The bowel and urinary tract are the most common sites of extragenital endometriosis. Laparoscopic management of extragenital endometriosis has been described since the 1980s. However, laparoscopic management of genitourinary endometriosis is still not widespread. Physicians are often unfamiliar with the signs and symptoms of genitourinary endometriosis and fail to consider it when a patient presents with bladder pain or hematuria, which may or may not be cyclic. Furthermore, many gynecologists do not have the experience to correctly identify the various forms of endometriosis that may appear on the pelvic organ, including the serosa and peritoneum, as variable colored spots, blebs, lesions, o...

The Journal of Obstetrics and Gynecology of India, 2018

Objective To assess the impact of hysteroscopic tissue removal systems (TRS) on histopathology ti... more Objective To assess the impact of hysteroscopic tissue removal systems (TRS) on histopathology tissue diagnosis. Measurements and Methods This is a paired-comparison ex vivo study in which 23 endometrial sections from hysterectomized uteri (13 benign and 10 hyperplasia/cancer

Journal of Lower Genital Tract Disease, 2008

Importance: Cervical stenosis is a challenging clinical entity that requires prompt identificatio... more Importance: Cervical stenosis is a challenging clinical entity that requires prompt identification and management in order to avoid iatrogenic injury at the time of endocervical canal cannulation. Objective: The aim of this study was to identify cervical stenosis and discuss associated etiologies, risk factors, and review medical and surgical approaches for overcoming cervical stenosis. Evidence Acquisition: Computerized searches of MEDLINE and PubMed were conducted using the key words "cervix", "cervical stenosis," "embryo transfer," "hysteroscopy complications," "misoprostol," and "ultrasound." References from identified sources were manually searched to allow for a thorough review. Data from relevant sources were compiled to create this review. Results: Transcervical access to the uterine cavity is frequently required for procedures such as hysteroscopy, dilation and curettage, endometrial biopsy, sonohysterogram, hysterosalpingogram, intrauterine insemination, embryo transfer in those undergoing in vitro fertilization, and insertion of intrauterine devices. These procedures can become complicated when difficult cannulation of the endocervical canal is encountered. Management strategies include preprocedural use of cervical-ripening agents or osmotic dilators, ultrasound guidance, no-touch vaginoscopy, manual dilatation, and hysteroscopic resection of the obstructed endocervical canal. Conclusions and Relevance: Cervical stenosis is associated with iatrogenic complications that can result in significant patient morbidity. In patients undergoing in vitro fertilization, difficult embryo transfer is associated with lower pregnancy rates. The clinician should carefully consider the patient's menopausal status, risk factors, and symptoms in order to anticipate difficult navigation of the endocervical canal. Various medical and surgical management strategies, including hysteroscopic resection, can be used to overcome the stenotic cervix. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After participating in this activity, the provider should be better able to diagnose cervical stenosis; distinguish associated etiologies and risk factors; and assess appropriate medical and surgical approaches.

Encyclopedia of Reproduction, 2018

Conception requires a series of coordinated, well-timed steps: ovulation, coitus, fertilization, ... more Conception requires a series of coordinated, well-timed steps: ovulation, coitus, fertilization, implantation, and gestation. These steps require the cooperation of multiple systems and organs in the body as well as a healthy male sperm and female egg. Disruption at any of these points can contribute to infertility. Advances in surgical technique have enabled surgeons to treat more challenging cases of infertility with less risk than in the past. An infertility workup begins with a good history and physical exam. Blood and semen samples, as well as imaging studies, often provide additional information. When no obvious diagnosis is elucidated from this initial work-up, videolaparoscopy may be considered for direct view of the abdomen and pelvis using a small telescope-like camera through small abdominal incisions. Treatment of any structural causes of infertility may be performed using specialized instruments that require small incisions and minimal recovery time. As a result of videolaparoscopy, there are more opportunities and less invasive approaches for physicians to intervene on behalf of patients facing infertility (Nezhat et al., 2013).

The development of non-obstetric endoscopic surgery in pregnancy is relatively recent. Studies in... more The development of non-obstetric endoscopic surgery in pregnancy is relatively recent. Studies investigating the use of anesthesia and the performance of non-obstetric surgery in pregnancy were not performed until the second half of the twentieth century. Around the same time, video-assisted laparoscopy was invented and pioneered by Camran Nezhat, and as it became embraced by the surgical community, it was also applied to the pregnant patient. Early concerns about the use of laparoscopy in pregnancy revolved around the unknown effects of anesthesia and pneumoperitoneum on the fetus, difficult surgical entry due to the enlarged uterus with a potential for uterine injury, and the physiologic changes inherent to pregnancy. Numerous studies have demonstrated the safety of anesthesia in pregnancy, and pneumoperitoneum has likewise been shown to be safe for the mother and fetus. Once the feasibility of laparoscopic entry was demonstrated, a variety of procedures were demonstrated to be sa...

Fertility and sterility, Oct 1, 2017

Journal of the Turkish German Gynecological Association, Jan 15, 2017

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestin... more Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first ...

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestin... more Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.

About 10% of all reproductive-aged women and 35% to 50% of women with pelvic pain and infertility... more About 10% of all reproductive-aged women and 35% to 50% of women with pelvic pain and infertility are affected by endometriosis. The disease typically involves the reproductive tract organs, anterior and posterior cul-de-sacs, and uterosacral ligaments. However, disease outside of the reproductive tract occurs frequently and has been found on all organs except the spleen. The bowel is the most common site for extragenital endometriosis, affected in an estimated 3.8% to 37% of patients with known endometriosis. Implants may be superficial, involving the bowel serosa and subserosa (FIGURE 1), or they can manifest as deeply infiltrating lesions involving the muscularis and mucosa (FIGURE 2, page 38). The rectosigmoid colon is the most common location for bowel endometriosis, followed by the rectum, ileum, appendix, and cecum (FIGURES 3, 4, and 5, pages 38-39). Case reports also have described endometrial implants on the stomach and transverse colon. Although isolated bowel involvement ...

acterized by endometrial glands and stroma outside of the uterine cavity. It is commonly associat... more acterized by endometrial glands and stroma outside of the uterine cavity. It is commonly associated with pelvic pain and infertility. Ectopic endometrial tissue is predominantly located in the pelvis, but it can appear anywhere in the body, where it is referred to as extragenital endometriosis. The bowel and urinary tract are the most common sites of extragenital endometriosis. Laparoscopic management of extragenital endometriosis has been described since the 1980s. However, laparoscopic management of genitourinary endometriosis is still not widespread. Physicians are often unfamiliar with the signs and symptoms of genitourinary endometriosis and fail to consider it when a patient presents with bladder pain or hematuria, which may or may not be cyclic. Furthermore, many gynecologists do not have the experience to correctly identify the various forms of endometriosis that may appear on the pelvic organ, including the serosa and peritoneum, as variable colored spots, blebs, lesions, o...

The Journal of Obstetrics and Gynecology of India, 2018

Objective To assess the impact of hysteroscopic tissue removal systems (TRS) on histopathology ti... more Objective To assess the impact of hysteroscopic tissue removal systems (TRS) on histopathology tissue diagnosis. Measurements and Methods This is a paired-comparison ex vivo study in which 23 endometrial sections from hysterectomized uteri (13 benign and 10 hyperplasia/cancer

Journal of Lower Genital Tract Disease, 2008

Importance: Cervical stenosis is a challenging clinical entity that requires prompt identificatio... more Importance: Cervical stenosis is a challenging clinical entity that requires prompt identification and management in order to avoid iatrogenic injury at the time of endocervical canal cannulation. Objective: The aim of this study was to identify cervical stenosis and discuss associated etiologies, risk factors, and review medical and surgical approaches for overcoming cervical stenosis. Evidence Acquisition: Computerized searches of MEDLINE and PubMed were conducted using the key words "cervix", "cervical stenosis," "embryo transfer," "hysteroscopy complications," "misoprostol," and "ultrasound." References from identified sources were manually searched to allow for a thorough review. Data from relevant sources were compiled to create this review. Results: Transcervical access to the uterine cavity is frequently required for procedures such as hysteroscopy, dilation and curettage, endometrial biopsy, sonohysterogram, hysterosalpingogram, intrauterine insemination, embryo transfer in those undergoing in vitro fertilization, and insertion of intrauterine devices. These procedures can become complicated when difficult cannulation of the endocervical canal is encountered. Management strategies include preprocedural use of cervical-ripening agents or osmotic dilators, ultrasound guidance, no-touch vaginoscopy, manual dilatation, and hysteroscopic resection of the obstructed endocervical canal. Conclusions and Relevance: Cervical stenosis is associated with iatrogenic complications that can result in significant patient morbidity. In patients undergoing in vitro fertilization, difficult embryo transfer is associated with lower pregnancy rates. The clinician should carefully consider the patient's menopausal status, risk factors, and symptoms in order to anticipate difficult navigation of the endocervical canal. Various medical and surgical management strategies, including hysteroscopic resection, can be used to overcome the stenotic cervix. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After participating in this activity, the provider should be better able to diagnose cervical stenosis; distinguish associated etiologies and risk factors; and assess appropriate medical and surgical approaches.

Encyclopedia of Reproduction, 2018

Conception requires a series of coordinated, well-timed steps: ovulation, coitus, fertilization, ... more Conception requires a series of coordinated, well-timed steps: ovulation, coitus, fertilization, implantation, and gestation. These steps require the cooperation of multiple systems and organs in the body as well as a healthy male sperm and female egg. Disruption at any of these points can contribute to infertility. Advances in surgical technique have enabled surgeons to treat more challenging cases of infertility with less risk than in the past. An infertility workup begins with a good history and physical exam. Blood and semen samples, as well as imaging studies, often provide additional information. When no obvious diagnosis is elucidated from this initial work-up, videolaparoscopy may be considered for direct view of the abdomen and pelvis using a small telescope-like camera through small abdominal incisions. Treatment of any structural causes of infertility may be performed using specialized instruments that require small incisions and minimal recovery time. As a result of videolaparoscopy, there are more opportunities and less invasive approaches for physicians to intervene on behalf of patients facing infertility (Nezhat et al., 2013).

The development of non-obstetric endoscopic surgery in pregnancy is relatively recent. Studies in... more The development of non-obstetric endoscopic surgery in pregnancy is relatively recent. Studies investigating the use of anesthesia and the performance of non-obstetric surgery in pregnancy were not performed until the second half of the twentieth century. Around the same time, video-assisted laparoscopy was invented and pioneered by Camran Nezhat, and as it became embraced by the surgical community, it was also applied to the pregnant patient. Early concerns about the use of laparoscopy in pregnancy revolved around the unknown effects of anesthesia and pneumoperitoneum on the fetus, difficult surgical entry due to the enlarged uterus with a potential for uterine injury, and the physiologic changes inherent to pregnancy. Numerous studies have demonstrated the safety of anesthesia in pregnancy, and pneumoperitoneum has likewise been shown to be safe for the mother and fetus. Once the feasibility of laparoscopic entry was demonstrated, a variety of procedures were demonstrated to be sa...

Fertility and sterility, Oct 1, 2017

Journal of the Turkish German Gynecological Association, Jan 15, 2017

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestin... more Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first ...

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestin... more Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.