Effects of presacral neurectomy on pelvic pain in women with and without endometriosis.
OBJECTIVE
Presacral neurectomy (PSN) is used in treatment of central chronic pelvic pain (CPP); however, the confounding effect of concomitant resection of endometriosis remains uncertain. This study was undertaken to evaluate and compare the effectiveness of presacral neurectomy (PSN) in the presence and absence of endometriosis.


METHODS
Twenty-three women with midline CPP (age 30.3 +/- 7.9, range 21-46) unresponsive to medical therapy were recruited to the study. Endometriosis was absent in seven and present in sixteen subjects. Laparoscopic PSN using a harmonic scalpel was performed in all subjects; simultaneous excision of endometriotic lesions was also carried out in subjects with endometriosis. Intensity of dysmenorrhoea and pelvic pain was measured by visual analogue pain scale (VAPS) at 3 and 12 months postoperatively.


RESULTS
Dysmenorrhoea decreased at 3 months by 75% (P = 0.018) in those without endometriosis and by 78% (P = 0.001) in those with endometriosis. At 12-months, dysmenorrhea increased in women with endometriosis (P = 0.008), but not in those without endometriosis. Pelvic pain not related to menses decreased by 67% (P = -0.0007) and by 87% (P = 0.028), respectively, in women with and without endometriosis. Dyspareunia, declined dramatically at 3 and 12 months to a median score of 0 (the majority of subjects had no discomfort; P < 0.001); the change in dyspareunia between 3 and 12 months was in favour of patients without endometriosis (P = 0.02)


CONCLUSIONS
PSN using a harmonic scalpel results in long-term pain relief, especially in patients without endometriosis.
Jedrzejczak
Piotr
P
Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, Poznan, Poland. piotrjedrzejczak@gmail.com
Sokalska
Anna
A
Spaczyński
Robert Z
RZ
Duleba
Antoni J
AJ
Pawelczyk
Leszek
L
D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology; D004414:Dyspareunia / Q000209:etiology; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery*; D010537:Peritoneum; D011044:Poland; D016896:Treatment Outcome; D055815:Young Adult