Adenexal lesion persisting for 12 wks with no internal/morphological changes is not a simple/hemorrhagic cyst for sure. Chocolate cyst and endometrioma are the same. so in this case cause for recurrence may be considered given that the cyst diagnosed after 5 months of laprotomy was not present initially. Usually these lesions do not present with radiating pain or frequency nor does ectopic pelvic kidney. TVS helps in defining and characterizing the pelvic pathology which is well known fact.  MRI may add some more information. Endometriosis should be excluded in such femaes.

I can not comment upon the statistics but a good suprapubic USG with moderately distended urinary bladder is as good as TVS in detecting the adenexal lesions, the later, however, is better in characterizing the  lesion.

I think prabhath precisely if the adenexal lesions of around less than 10 weeks size and which located more posteriorly in such conditions Transvaginal ultrasound will give better information about size,site,texure and the nature of adenexal lesions.the lesion abdominally palpable can give better results with good suprapubic ultrasound with partially filled bladder.sometimes it requires both transvaginal and suprapubic ultrasound.the pelvic kidney with short ureter sometimes gives pain as adenexal lesion was close to it.

PPV for pelvic ultrasound needs further studies, but as for as me concerned the PPV for pelvic ultrasound is not fixed. Either due to advancement in the Ultrasound modalities and operator skill. State of Art Ultrasound systems largely improved the Sensitivity and specificity of ultrasound in pelvic sonography. TAS and TVS are considered complementary to each other, for gross and relative appearance of pelvic organs TAS is used with full bladder but for detailed study TVS is used with empty balder.