Cyst Aspiration

Overview

Ovarian cysts are fluid-filled sacs or pockets that exist inside or on the surface of the ovary. On each side of the uterus, women have two ovaries, each roughly the size and shape of an almond. During the reproductive years, eggs (ova) grow and mature in the ovaries and are released in monthly cycles.

Many women develop ovarian cysts at some point in their lives. Most ovarian cysts cause no pain and are completely safe. Without therapy, the vast majority of cases disappear after a few months.

However, ovarian cysts, particularly burst cysts, can cause significant symptoms. Get frequent pelvic examinations and be aware of the signs that might indicate a potentially significant condition to safeguard your health.

 

What are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop within or on top of one or both ovaries. A cyst is a broad word for a fluid-filled formation. Ovarian cysts are normally asymptomatic; however, abdominal or pelvic discomfort is prevalent.

 

What Do Your Ovaries Do?

Your ovaries are important in both menstruation and fertilization. They create the hormones estrogen and progesterone as well as eggs for fertilization. Ovulation occurs when an ovary produces an egg in the middle of your menstrual cycle (about day 14 of a 28-day cycle).

There are hundreds of ovarian follicles in each of your ovaries. Ovarian follicles are tiny sacs in the ovaries that contain developing eggs. Follicle-stimulating hormone (FSH) stimulates follicles in one of your ovaries to develop each month, between days six and fourteen of your menstrual cycle. A increase in luteinizing hormone (LH) on day 14 of the menstrual cycle induces the ovary to produce an egg (ovulation).

The egg begins its journey to the uterus by passing via the fallopian tube, a small, hollow structure. Progesterone levels grow when the egg passes via the fallopian tube, helping to prepare the uterine lining for pregnancy.

If you do not become pregnant during that cycle, the egg degrades and is reabsorbed by your body, allowing menstruation to begin.

 

Who is Affected By Ovarian Cysts?

An ovarian cyst can occur in anybody who has ovaries. Your chances improve as a result of:

• Age. If you haven't gone through menopause, ovarian cysts are more prevalent.
• Pregnancy status. During pregnancy, cysts are more likely to develop and persist.
• Ovarian cyst history. If you've had an ovarian cyst previously, you're more likely to get another.
• Current medical issues. You are more prone to develop an ovarian cyst if you have endometriosis, hormone issues, or are taking ovulation-inducing drugs such as clomiphene.

 

Ovarian Cyst Symptoms

An ovarian cyst normally only produces symptoms if it breaks (ruptures), is very big, or limits the ovaries' blood supply.

In certain situations, you may have:

• Pain during sex. 
• Difficulties emptying your bowels.
• Frequent need to urinate. 
• Heavy periods, irregular periods, or lighter periods than usual.
• Bloating and a large belly feeling. 
• Very full after only eating.
• Difficulties becoming pregnant –however ovarian cysts normally have little effect on fertility.

 

Ovarian Cyst Types

1. Functional Cysts. The majority of ovarian cysts develop spontaneously throughout a woman's reproductive years as a result of menstrual cycles. Your ovaries produce small follicles before to ovulation. When you ovulate, the follicles produce hormones and eject the egg. A functional cyst occurs when a normal follicle continues to develop and hold fluid after your menstrual cycle. They are virtually always harmless, and usually diminish and disappear on their own within four to eight weeks.
2. Benign Neoplastic Cysts. These cysts are uncommon and come in a variety of morphologies. These cysts are distinguished by aberrant tissue development. The most frequent kind of benign neoplastic cyst is the cystic teratoma, commonly known as a dermoid cyst. These cysts, which form from a germ cell, can include a variety of tissues, including sebaceous glands, skin cells, and hair follicles. These cysts do not always cause symptoms, but they can occasionally induce additional medical issues including pelvic discomfort. These cysts usually do not go away on their own.
3. Endometriotic Cysts. These cysts form as a result of endometriosis when endometrial-like tissue develops outside of the uterus and gets linked to the ovaries. Hormones cause uterine tissue to shed and exit the body after ovulation during a menstrual cycle. Endometrial tissue on the ovaries cannot be shed, leading it to collect and develop dark, reddish brown cysts. As a result, endometriotic cysts are frequently referred to as "chocolate cysts." These cysts do not normally cure on their own and, if ruptured, can cause pelvic discomfort, adhesions, and infertility.
4. Malignant Cysts. Although most cysts are benign, any form of cyst can become malignant or cancerous. Ovarian cancer is diagnosed by a malignant cyst or tumor. When specific characteristics are found during a physical exam, ultrasound, or in a patient's medical history, a cyst is thought to be malignant. In this case, a biopsy or full cyst removal is recommended.

 

Causes of Ovarian Cyst

There are several causes of ovarian cysts, depending on the type:

• Hormonal variables and medicines that aid in ovulation can result in follicular and corpus luteum cysts, also known as functional cysts.
• Endometriosis raises the chance of developing endometriomas.
• During pregnancy, the corpus luteum cyst produces progesterone to keep the pregnancy going. The placenta takes up this job, and the corpus luteum cyst normally disappears. If it continues or grows in size, a surgeon may need to remove it.
• Cysts can arise as a result of infections that damage the ovaries and fallopian tubes.

 

How is Ovarian Cyst Diagnosed?

Because most ovarian cysts have no symptoms, they frequently go untreated. Screening for an unrelated pelvic condition may occasionally reveal the presence of a cyst.

If a patient presents to a doctor with symptoms, the doctor will:

• ask about symptoms.
• ask about the individual's medical history.
• Perform tests to determine the shape and size of the cyst, as well as if it contains a solid or liquid.

Among the diagnostic tests available are:

• Ultrasound exam.
• Blood test.
• Test for pregnancy.
• In some circumstances, an MRI or CT scan is required.

 

What Happened If Ovarian Cyst Not Aspirated?

1. Rupture. An ovarian cyst rupture is rather common in women of reproductive age. This can be mild and go unnoticed, but it is also linked to a rapid onset of lower abdominal discomfort, usually on one side of the body. The discomfort generally starts when you do anything that causes the cyst to rupture. Other disorders with comparable symptoms include ovulation discomfort, ectopic pregnancy, and ovarian torsion, all of which must be checked out before determining a treatment strategy. Often, ruptured cysts do not require treatment beyond pain medication and observation; but, if a woman's blood pressure becomes unstable or bleeding continues, surgical intervention may be required.
2. Torsion of the ovaries. Ovarian cysts can develop to the point that they force the ovary to twist out of its natural position, partially or completely blocking blood flow to the ovary. This is known as ovarian torsion. Lower abdominal discomfort, typically unilateral, as well as nausea or vomiting, are common symptoms. It is one of the most prevalent gynecologic emergencies that necessitates surgical intervention to address.
3. Cancerous cyst. After-menopause ovarian cysts are more likely to be malignant than cysts that originate before menopause.

 

How to Prepare?

This operation may be deemed elective and will be planned in advance through your doctor's office. Blood and fluid loss from ruptured ovarian cysts may need emergency cyst removal surgery. You should plan on missing a few days of work for the operation and the recovery time after the surgery.

• Location

The excision of an ovarian cyst takes happen in a hospital operating room or an outpatient surgery center.

 

• Food & Drink

Patients will be instructed by the surgeon not to eat or drink anything after midnight the night before the procedure. Smoking and alcohol should be avoided for at least one day before surgery, if not longer.

Specific foods may aid in the treatment of ovarian cysts, which can be caused by PCOS or a hormonal imbalance. There are several websites and anecdotal reports regarding certain diets treating ovarian cysts by the consumption of specific foods. However, no research studies have validated any claims that eating may cure ovarian cysts.

• Medications

Patients should give a detailed list of their current medicines, including any prescription or over-the-counter medications, supplements, vitamins, or recreational substances. Depending on each patient's medical status, the surgeon will assess if drugs that cause greater bleeding, such as blood thinners, should be maintained or discontinued.

• What to Bring?

You must plan for a ride home from the hospital with a support person. The anaesthetic used during the treatment will make driving unsafe.

When Ovarian Cyst Aspiration is Indicated?

Inclusion criteria were as follows:

• A unilateral simple ovarian cyst that had persisted for more than 6 months before the procedure.
• Cyst diameter more than 30 mm.
• No family history of ovarian cancer.
• No evidence of renal or hepatic disease.
• A normal value (35 IU/mL) of serum CA-125 before the procedure
• No large amount of free fluid in the pouch of Douglas, for fear of starting a torsion of the cyst.
• No previous puncture of the cyst.
• No lower abdominal or pelvic pain.
• At US, a simple cyst was defined as a cyst with no papillary projections, a clearly defined wall, and clear content. Endometriosis was suspected at US when diffuse low-level echoes were observed within a cyst that had persisted for more than 2 months, and the diagnosis was proved by means of cytologic findings after aspiration in all cases. Although color Doppler US was used in many cases to examine the neovascularity of the cyst, specific Doppler studies were not done routinely in every patient; therefore, Doppler indexes were not used for the diagnostic evaluation of benignancy.

The exclusion criteria were as follows:

• The existence of US signs that cast doubt on the cyst's benign nature (localized parietal thickening, irregularity of the wall, endocystic vegetation, the presence of several partitions, and presence of internal granulation or intracystic tissue mass). Bowel loops, bladder, or uterine interposition
• The patient's informed permission was not obtained.

 

What to Expect Before the Surgery?

On the day of operation, a nurse will check your vital signs, weight, pregnancy status, and blood sugar level, if applicable. Patients will change out of their clothing and jewelry and into a surgical gown. Surgical and anesthesia consent forms will be reviewed and signed.

The anesthesia experts will do another comprehensive examination to detect any risks associated with general anesthesia. During the procedure, an intravenous (IV, through a vein) catheter will be implanted to provide any drugs that are required.

The operating area will be exceedingly cold and already equipped with a special surgical bed, medical equipment and monitors, and several surgical tools. During surgery, you will be positioned on your back, and you will fall asleep after the anesthesiologist's medicine takes effect. To assist you breathe, the anesthesiologist will place a breathing tube (endotracheal tube) that is connected to the ventilator.

The surgical team will clean the operative site with an antiseptic solution. Sterile drapes will be draped across your body, exposing just the surgical region.

 

What Happens During Ovarian Cyst Aspiration?

A 21-gauge spinal needle was used to puncture the cysts transabdominally. The approach employed was freehand, with direct US direction given via a convex 3.5-MHz probe linked to a US machine. Following cyst puncture, as much fluid as feasible was drained, and a single dosage of methotrexate (30 mg diluted in 3 mL of normal saline) was administered. The doctor left a tiny quantity of fluid in the cyst before injecting methotrexate in all cases to ensure that the needle stayed inside the cyst following aspiration.

All surgeries were conducted as outpatients, with neither general or local anaesthetic or antibiotics administered. In all cases, the aspirated fluid was submitted for cytologic examination. Despite the fact that the cyst puncture is not painful, patients were asked to record any subjective pain feelings they experienced during the treatment.

Patients with endometriomas were also asked to report pain sensations prior to the operation and any differences thereafter. There were no surveys employed, and pain was described subjectively. Patients were told to take their temperature at least twice a day for the next 5 days (to check for infection) and to report any symptoms they encountered. Any difficulties that occurred during or after the surgery were documented.

 

Risks of Ovarian Cyst Aspiration

Although Ovarian Cyst is typically safe, there are certain dangers, as with any operation. These are some examples:

• Bleeding: If you bleed excessively during surgery, you may require blood transfusions.
• Harm to neighboring organs: Surgery may cause damage to your bladder or colon, although this is uncommon. It happens in fewer than 1% of all instances.
• Infection: You might acquire one several days, if not weeks, following surgery. It may result in a fever, as well as redness and discomfort near the wound.
• Hernia: Sometimes the muscle near the wound becomes weak.
• Retention of ovarian cells: Your ovary cells may continue to cause difficulties, such as soreness around your pelvic.
• Fertility loss: If both ovaries are removed, you'll require a procedure like in vitro fertilization (IVF) to get pregnant.

Before your operation, the doctor will go over the risks with you. If they recommend this operation, it indicates they believe the advantages exceed the risks for you.

 

Is Ovarian Cyst Aspiration Painful?

In all cases, the aspirated fluid was submitted for cytologic evaluation. Despite the fact that the cyst puncture is not painful, patients were asked to record any subjective pain feelings they encountered during the treatment.

 

When Should I Call My Healthcare Provider?

If any of the following occur, contact your healthcare provider:

• Your menstrual cycles are irregular, late, or uncomfortable.
• Your stomach ache is not going away.
• Your abdomen swells or becomes huge.
• You are having difficulty urinating or emptying your bladder.
• You experience discomfort during intercourse.
• You are experiencing abdominal fullness (bloating), pressure, or pain.
• You lose weight for no obvious reason.
• You are typically unwell.

Get help immediately if you notice signs of ovarian torsion:

• Severe stomach discomfort that occurs unexpectedly and is accompanied by vomiting or fever.
• Feeling dizzy or faint, and breathing quickly.
• Skin that's cold and clammy.

 

Conclusion

Ovarian cysts are extremely common, particularly if you have not yet reached menopause. The most frequent form of ovarian cyst is a functional cyst.

A fluid-filled sac that forms on one of your ovaries is known as an ovarian cyst. Many are caused by monthly hormone changes, which normally resolve on their own within a few weeks without therapy. Ovarian cysts are frequently asymptomatic. However, if they grow in size or do not settle on their own, you may require treatment.

The most frequent types are harmless, do not produce symptoms, and eventually fade away on their own. Cysts can occasionally develop issues that necessitate the attention of your physician. Having frequent pelvic examinations might help lower your chances of having cyst problems.

Large cysts, unpleasant symptoms, or abnormal imaging may necessitate ovarian cyst removal or aspiration surgery.