Histopathologic findings on uterosacral ligaments in women with chronic pelvic pain and visually normal pelvis at laparoscopy.
OBJECTIVE
To determine the prevalence and type of microscopic findings on laparoscopically resected uterosacral ligaments in women with chronic pelvic pain and no visible pelvic disease. The effect of this procedure on the patients' level of pain also was assessed as a secondary objective.


METHODS
Prospective follow-up (Canadian Task Force classification II-2).


METHODS
University-affiliated hospital.


METHODS
Twenty-seven premenopausal women undergoing diagnostic laparoscopy for chronic pelvic pain had a normal pelvis on visual inspection. All patients underwent resection and histologic evaluation of the uterosacral ligaments. Pain relief was evaluated by use of a questionnaire administered before and at 3, 6, and 12 months after surgery.


RESULTS
Microscopic examination identified endometriosis in 2 (7.4%), endosalpingiosis in 3 (11.1%), and inflammation in 14 (51.9%) patients. Laparoscopic uterosacral ligament resection was associated with a reduction in dysmenorrhea (p < or = .001), with 14 (52%) patients reporting improved or resolved symptoms. There was a statistically significant decrease in dyspareunia (p < or = .01) and in the severity of noncyclical pain (p < or = .002). Thirty-five percent of patients no longer required medication for pain control (p < or = .005). The number of days needed off work also decreased.


CONCLUSIONS
Despite normal laparoscopic appearance, microscopic endometriosis, endosalpingiosis, and inflammatory changes were found in uterosacral ligaments in 17 (63%) women with chronic pelvic pain. Laparoscopic resection of uterosacral ligaments improved dysmenorrhea, dyspareunia, and noncyclical pain and decreased the number of days lost from work, as well as the proportion of patients who required medication for pain control.
Nascu
Patricia C
PC
Department of Obstetrics and Gynecology, St. Joseph's Health Care, The University of Western Ontario, London, Ontario, Canada. pnascu@uwo.ca
Vilos
George A
GA
Ettler
Hellen C
HC
Abu-Rafea
Basim
B
Hollet-Caines
Jackie
J
Ahmad
Riad
R
D000290:Adnexa Uteri / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy; D008022:Ligaments / Q000473:pathology* / Q000601:surgery; D017699:Pelvic Pain / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome