Ultrasound-guided transvaginal cyst aspiration for the management of pelvic pseudocyst: A preliminary experience

Background: While some research has been reported on the use of transvaginal ultrasound-guided aspiration of ovarian cysts, none has been reported for pseudocysts. Sometimes laparotomy patients experience recurrent pelvic psuedocysts for which they may need to undergo another laparotomy. The use of transvaginal ultrasound-guided aspiration of pelvic pseudocysts may make repeated laparotmies unnecessary. Methods: Between April 1993 and October 2001, 14 outpatients with postoperative pelvic pseudocysts underwent transvaginal ultrasound-guided aspirations with or without surgical starch irrigation. All patients had previously undergone pelvic surgeries for adenomyosis and leiomyoma, except one was stage Ib cervical cancer. A total of 25 treatment cycles by transvaginal ultrasound-guided aspiration were included: 15 cycles with starch and 10 cycles without. Results: The 13 patients with more than 6 months follow-up had a total of 25 aspiration cycles, 22 of which (88%) had no recurrent cyst by the end of their 6-month follow-up period. Eighteen out of 25 cycles (72%) had no evidence of recurrence after 12 months of follow-up. Five patients needed only one aspiration to become disease free and six patients needed two aspirations. Only 2 patients needed 3 or more aspirations procedures. After 12 months of follow up, 33% of those irrigated with starch had a recurrent pelvic pseudocyst while 30% without starch experienced recurrence. Conclusion: Because it eliminates necessity of repeat laparotomy, transvaginal ultrasound-guided aspiration of pelvic pseudocysts may become a preferred treatment for recurrent pelvic pseudocysts.