Surgical Evaluation and Treatment of the Patient with Chronic Pelvic Pain

Holloran-Schwartz, M.B.

doi:10.1016/j.ogc.2014.05.003

Cited by 17 publications

(10 citation statements)

References 42 publications

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“…19 Laparoscopic findings were normal in 13 out of 65 women (20%) whereas these were abnormal in 52 women that are comparable with previous studies. 20,21 Histological evidence of genital TB was reported in 12.5% (3/24)women that is comparable to other studies from India. 9,15,22,23 AFB culture reported positive in 16.66% (4/24) women which is comparable to studies by Jindal and Bose.…”

Section: Discussionsupporting

confidence: 87%

Role of AFB culture, histopathology and laparoscopy in female genital tuberculosis as a cause for chronic pelvic pain

Sharma¹,

Sharma²,

Bharadwaj³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: As Female genital tuberculosis is an important cause of significant morbidity presenting mainly as infertility and chronic pelvic pain so the study was proposed to estimate the prevalence of genital tuberculosis in women with idiopathic chronic pelvic pain by AFB culture, histopathology and laparoscopy.Methods: In this prospective study, we enrolled 65 women with idiopathic chronic pelvic pain. Diagnostic laparoscopy was done and Endometrial biopsy or menstrual blood was taken and sent for AFB culture and histopathological examination.Results: In this study, the prevalence of genital TB in women with CPP was 35.38% (24/65) of which23 had gross findings of genital TB and one had pelvic congestion with positive result in AFB culture. Laparoscopic findings were normal in 13 out of 65 women (20%) whereas these were abnormal in 52 women. Histological evidence of genital TB was reported in 12.5% (3/24) women. AFB culture reported positive in 16.66% (4/24) women.Conclusions: Genital tuberculosis is an important cause for idiopathic chronic pelvic pain mainly in developing countries. AFB culture of menstrual blood is a simple, noninvasive test that is useful many times especially in unmarried girls or those who are not willing for invasive tests. Laparoscopy is an excellent tool in diagnosis of genital TB as it allows direct visualization.

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Section: Discussionsupporting

confidence: 87%

Role of AFB culture, histopathology and laparoscopy in female genital tuberculosis as a cause for chronic pelvic pain

Sharma¹,

Sharma²,

Bharadwaj³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…Surgical interventions, sometimes may be diagnostic, should be guided by the underlying diagnosis. Diagnostic laparoscopy, conscious laparoscopic mapping, adhesiolysis, surgical excision of ovarian remnant, and hysterectomy are the among the most common surgical procedures in the management of chronic pelvic pain [4].…”

Section: Introductionmentioning

confidence: 99%

Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Uğurlucan¹,

Yaşa²

2021

Chronic Pain - Physiopathology and Treatment

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Chronic pelvic pain affects 2-24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea-and endometriosis-related pain. But recent randomized studies and metaanalysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter.

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“…9 In another study of chronic pelvic pain patients treated surgically, endometriosis was present in 33%. 4 There is poor correlation between operative findings and histopathological diagnosis with a positive predictive value as low as 45% according to one study. 10 This lack of concordance between surgical findings and histology makes the interpretation of the true prevalence of endometriosis among chronic pelvic pain patients hard to decipher.…”

mentioning

confidence: 97%

“…the umbilicus, the lumbosacral back, or the buttocks, and is of sufficient severity to cause functional disability or lead to medical care." 4 Multiple studies have noted that the severity of symptoms do not correlate with the extent of disease based on American Society for Reproductive Medicine (ASRM) staging (►Figs. 1-2).…”

mentioning

confidence: 99%

“…1,5 However, there are data to suggest that women with more advanced stage endometriosis do get more pain relief after surgery than women with mild or minimal disease (►Figs. [3][4][5][6]. 6,7 It is important to note that the gold standard for diagnosing endometriosis is surgical excision with histopathologic evidence of endometriosis confirming visual inspection on laparoscopy.…”

mentioning

confidence: 99%

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Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain

Flyckt

Kim

Falcone³

2017

Semin Reprod Med

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Surgical approaches to endometriosis patients with chronic pelvic pain are multimodal and require individualization. Laparoscopic approaches are preferred over laparotomy when conservatively treating endometriosis via excision or ablation/fulguration of lesions. The available data support cystectomy over fenestration or fulguration for endometriomas; however, there may be associated decreases in ovarian reserve with endometrioma treatment. Presacral neurectomy may be useful in patients with midline pain and LUNA is not effective for the treatment of pelvic pain related to endometriosis. Appendectomy may be considered prophylactically at the time of the surgery for pelvic pain, although more studies are needed. For deep infiltrating endometriosis, the risks of aggressive bowel surgery must be weighed against the benefits of clear pain reduction. Postoperative medical suppressive therapy is strongly recommended to prolong symptom-free intervals of this chronic disease. As definitive therapy, hysterectomy can be helpful especially when combined with endometriosis excision. When performing hysterectomy, bilateral oophorectomy should be given careful consideration, as this procedure leads to premature surgical menopause and may not decrease the possibility of reoperation and persistence of symptoms in patients aged 30 to 39 years with chronic pain.

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Surgical Evaluation and Treatment of the Patient with Chronic Pelvic Pain

Cited by 17 publications

References 42 publications

Role of AFB culture, histopathology and laparoscopy in female genital tuberculosis as a cause for chronic pelvic pain

Role of AFB culture, histopathology and laparoscopy in female genital tuberculosis as a cause for chronic pelvic pain

Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain

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