title: Transvaginal aspiration of ovarian cysts: long-term follow-up.
abstract: OBJECTIVE
  Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy.
  
  
  METHODS
  Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness.
  
  
  RESULTS
  Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy.
  
  
  CONCLUSIONS
  Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.
authors.affiliation: Department of Academic Radiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Duke
authors.forename: J
authors.initials: J
authors.lastname: Colville
authors.forename: A
authors.initials: A
authors.lastname: Keeling
authors.forename: D
authors.initials: D
authors.lastname: Broe
authors.forename: T
authors.initials: T
authors.lastname: Fotheringham
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014621:Vagina