International Medical Conference Endometriosis 2025:
Endometriosis 2025: Your Mother Should Know, Your Doctor Should Know Better!
Discussion - USG and Early Detection
Thank you everyone. Any questions from the
Audience? Thanks so much. I would like to thank all of you, Anna. I would like to ask you about the MRI, the place of MRI. You have a good sonographer and also you have a good surgeon. You can do the ultrasound very well. But we know that if the patient has some surgeries, then the ultrasound features completely different standards, endometriosis cases. And so in that situation, maybe the MRI take a good role in the evaluations. What is the percentage of MRI in daily practice and in which conditions do you choose direct MRI.
But slowly, slowly, we don't perform bar, which we performed in the past for bowel never. Now we perform it never. The MRI we performed for aosis. Now never, we don't do it in cases of already operated patients because that's true that sometimes you have a lot of adhesions, sometimes you have fibrosis. But anyway, you can recognize it and it's a little bit different from active nodules. They are hyper coic and the fibrosis or the lesions after operation, the lesions are hyper coic. So I think it's not so a big problem while the nerve structures for moment for me, yes, perhaps Shabo who describes his speaker experience in Hungary. He says that in nine seconds he performs this ultrasound and he has very no, that means he has a good experience, which I personally don't have yet. I hope perhaps next time I come here with another experience, because as you remember in Congress they asked me and I was not able to see, and it was some months ago and now we started.
Hi, I thank you all for your talk, my questions for you Dr. Mechner. So in Germany here we have a significant delay to diagnosis, especially in young girls, young adolescents, young women, but in Germany, since there's a preference for a holistic approach and natural approach, what do you find in terms of when surgeons, when obstetricians or when young women will actually be comfortable with a laparoscopic or some kind of imaging work to confirm a diagnosis of endometriosis?
Thank you for the question. So now we have also in Germany the same delay of diagnosis. We have endometriosis centers, so that is a big advance in the system, but we have the system that we have gynecologists like gps, patients have to go to the GP gynecologist and they have to give them the referral to the center. The patients are not go by themselves normally. So that is a system. But we have the problem with the private gynecologists that they have no time, they have no clue the normalization of the dysmenorrhea. And so we have also the problem with a delay of diagnosis. And then it's not only my center, but the focus of the multimodal treatment is not common in Germany because most of the centers are localized in ambulance surgical centers or we have the university centers and the hospital, the normal hospitals, the general hospital exit.
Thank you. And the general hospital has no outpatient clinic, so they can't give any prescriptions for hormones, for physiotherapy. They can't do nothing. They can do only the surgery. So everybody wants to do the surgery, to earn money, to make the diagnosis, and nobody take care. Then for the patients later on, they send them back to the private gynecologic colleagues, but they have no clue about endometriosis as a chronic disease. So it absolutely makes no sense in the way we are working about it. Absolutely. The health system has so much money in Germany. It's a really rich system and you can do three or four laparoscopies and the health insurance is paying everything, but they don't pay physiotherapy.
It's easier to get a next surgery than to get a physiotherapy agricul. No, of course not. No. But physiotherapy is covered by the health insurance, but gynecologists have no experience and they are not willing to give the prescription. They have to give a prescription. They have a fixed budget they have for each patient, and that is 15 euros. That means for each patient for three months period. That means when they give a prescription for a painkiller ibuprofen, the cost is 16 euros around, or they can do it once or when they give reco, for example, for 300 euros, that means two 20 other people can't get anything. It's not T not really sufficient. Really.
Yes, I absolutely agree. Because these both exams are very operator dependent and also machine dependent and also time dependent. So you have to decide that if you perform ultrasound, it's not general ultrasound, but it's second level ultrasound. That means the patient should know how much time she has for this and also it shouldn't be performed in a quarter of hour during general visit with a machine of 10 years ago and so on. But you have to have your machine. That means machine, but also enough time to perform it. Of course, yeah. Yeah. So I agree with you, completely with you, but perhaps what is our message is not to stop because sometimes we decide at this point I stop and this is the field of radiologist, or this is a field of someone who is ultrasonographer, but why surgeons should not be curious if they want just a little bit expand also to learn something because, or at least collaborate, very stressed. They're very straightly with sonography because you have to speak the same language. We have to share the knowledge about anatomy and about pathology and only like that you can work. But if you at least try, I think you are a better surgeon and you are a better ultrasonographer. Just looking for both. Okay. Thank you so much.
