Ovarian Sliding Sign As a Predictor of Ureterolysis at Laparoscopy in Women with Endometriosis: Retrospective Observational Study

Study Objective To determine whether a negative ovarian “sliding sign” (i.e. fixed ovary) during pre-operative transvaginal ultrasound (TVU) is useful in predicting the need for ipsilateral ureterolysis, for women with suspected endometriosis undergoing laparoscopic surgery. Design Retrospective observational study. Setting Hospital based. Patients or Participants 66. Interventions All women undergoing laparoscopic surgery for suspected endometriosis were assessed for ovarian mobility at TVU using the ovarian “sliding sign” technique. Data was analysed to determine the diagnostic accuracy of a negative ovarian “sliding sign” for the prediction of ipsilateral ureterolysis. Measurements and Main Results Complete TVU and surgical data was available for 66 women. The age range was from 18-52 years (Mean =31.5 years). Incidence of right left and any fixed ovary at TVU was 22/66 (33%), 24/66 (36%) and 27/66 (41%) respectively. Incidence of ureterolysis (partial or complete) at surgery for right, left and either pelvic sidewall was 10/66, (15%), 18/66 (27%) and 22/66 (33%) respectively. The sensitivity/specificity/positive predictive value /negative predictive value for the ovarian “sliding sign” at TVU for the prediction of ipsilateral ureterolysis was:Right ovary 80%/75%/36%/95% and left ovary 44%/66%/33%/76%. The crosstab for relationship between a negative ovarian “sliding sign” of the left ovary and left ureterolysis was not significant (p =0.437) but was significant for the right ovary and right ureterolysis (p =0.002). Conclusion A negative right ovarian “sliding sign” (i.e. fixed right ovary) at pre-operative TVU was significantly associated with the need for right ureterolysis. In addition, a positive ovarian “sliding sign” (i.e. mobile ovaries) at TVU demonstrated a high NPV for the need for laparoscopic ureterolysis. The TVU ovarian “sliding sign” may therefore be a useful ultrasound soft marker for predicting which women are at increased risk of requiring ureterolysis at surgery, and thus, aid in the pre-operative planning and counselling for these women.