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

Abstract

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.